McCall McPherson explains why patients struggle with T3 medications. Most intolerance comes from doses going up too fast, she says. Her approach: increase liothyronine in 2.5 µg steps and desiccated thyroid in 15 mg steps, spread over weeks. True adrenal problems causing intolerance are rare.
Questions this video answers
2.5 µg
15 mg
Multiple 2.5 µg increases over the course of a month
Exceedingly rare — about two patients out of thousands (speaker's estimate)
Chapters
You think you can't tolerate T3 medications like lyothyrenine, cytomel, NP, armor. Let's talk through that. I got this question a lot from you guys, so I'm answering it. So if in most cases, people cannot tolerate T3 because of clinician error or the clinician not knowing how to navigate medications correctly, so often it's because they are increasing their dose too quickly, they are putting them on too much, or they're not using small enough dose increases over time to effectively get them to where they need to be. To give you, like, concrete information. When I put someone on cytomel or lyothyrene, which is pure T3, I got distracted. Oliver's always trying to make an appearance. So with Cytomel lyothyrene, I increase in 2.5 microgram tablets. I do this in multiple times over the course of a month. But to give you a little bit of concrete data, that's the dose I adjust with. When it comes to armor or NP, I always adjust in 15 milligram doses. No more. I still, again, I increase people in small microscopic doses over time. So I increase them multiple times each treatment cycle, but always only in the context of 15 milligram doses. Another reason why you can't tolerate T3, your starting TSH is too high. The higher someone's TSH is, the more prone to side effects with T3 that they are. So sometimes what has to happen is we have to prime someone's body with enough T4 to lower their TSH to facilitate them being able to tolerate T3 and enough that it is a therapeutic dose. So that's kind of a big, big workaround. And then the third that you guys hear a lot, like on social media and blogs and things, is fix your adrenals before you fix your thyroid. You won't tolerate T3 if you have adrenal issues. That might account for.000,0001% of my patients. 99.9999. And in fact, really, I think out of thousands and thousands of people that I've treated, I've probably had two that couldn't tolerate T3. So it's exceedingly rare if the clinician does their job correctly and is able to facilitate things in a way that promotes your physiology to tolerate T3. So I hope that helps.
