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Liothyronine – Cytomel

Thyroid hormones, essential for metabolic regulation, are produced naturally by our bodies. However, many pharmacological companies manufacture synthetic versions of these hormones. The primary types include T4 (levothyroxine) and T3 (liothyronine), both stored in the thyroid gland.

Pharmaceutical thyroid hormones are created using two methods: either animal-derived (from bovine or ovine sources) or synthesized. In the USA, the iodine content in thyroid preparations is strictly regulated.

Cytomel (liothyronine sodium) is available in both tablet form and as a naturally occurring thyroid hormone salt. Notably, T3 is significantly more potent than T4.

Pharmacology

The exact mechanisms of thyroid hormone action remain largely unclear, yet they play a critical role in numerous biochemical processes within cells, enhancing energy utilization. By increasing the metabolism of carbohydrates, lipids, and proteins, they elevate oxygen consumption, leading to a higher basal metabolic rate and affecting nearly every organ system within the body. The profound impact of thyroid hormones is particularly evident in patients suffering from deficiencies.

Dosage

Thyroid hormones are absorbed rapidly into the bloodstream from the digestive tract. While initial effects may begin within hours, peak activity arises over several days, with residual effects lasting for days post-administration due to binding with albumin in the blood, which protects them from liver breakdown.

• For replacement therapy in hypothyroidism
• Replacement therapy post-thyroidectomy
• Treatment for goiters and thyroid nodules
• Diagnostic agents in hyperthyroidism suppression tests
• Alternatives for individuals allergic to pork or beef thyroid, such as Cytomel

Body Builders and Weight Loss

For decades, athletes have misused thyroid hormones for weight loss and enhanced athletic performance due to their ability to burn fat and carbohydrates. Cytomel is widely employed in various sports, typically taken orally for 4-6 weeks and discontinued shortly before competitions for maximum effect. It is recognized as an effective fat burner that increases energy levels; however, this practice is complicated by the concurrent use of other supplements and hormones.

Online sources recommend starting Cytomel at 25 ug/day for weight loss, gradually increasing the dose by 5-10 ug/day. The upper limit is 100 ug/day to minimize side effects. Anecdotal evidence suggests weight loss may take 6-12 weeks, but users must taper off doses gradually to prevent thyroid insufficiency due to suppression. Consultation with a physician is crucial for those considering off-label use of thyroid hormones.

Signs and Symptoms

Excessive thyroid hormone can produce diverse side effects including:

• Headaches
• Mood swings—irritability, nervousness, anxiety
• Increased sweating
• Irregular heart rhythms
• Palpitations
• Chest pain
• Diarrhea
• Menstrual irregularities
• Worsening heart failure
• Shock

Severe overdoses may induce thyroid storm-like symptoms, while chronic overdosage leads to hyperthyroidism signs.

Contraindications

Thyroid hormone treatment is contraindicated in individuals with untreated adrenal insufficiency, thyrotoxicosis, or hypersensitivity to its components. True allergies to liothyronine are considered rare.

Care with Combinations

Weight loss pursuits often lead to combined use of thyroid hormones with supplements, yet therapeutic doses typically yield ineffective weight loss results. Larger doses pose significant dangers, especially when used alongside stimulants like ephedrine or growth hormones.

Care must be exercised in patients with existing health conditions such as adrenal insufficiency, diabetes mellitus, and increased anticoagulant sensitivity; dosages may need adjustment. Thyroid hormones should never be recommended for infertility treatment without scientific backing.

Individuals with cardiac issues should consult a physician before initiating thyroid therapy, utilizing the minimal effective dose.

Levels

Thyroid hormone levels can be readily assessed, with organizations like the IOC and WADA screening athletes for these hormones using sensitive radioimmunoassays.

Drug Interactions

Liothyronine may interact with various medications, including:

• Oral anticoagulants
• Insulin and oral hypoglycemics
• Cholestyramine
• Estrogens and oral contraceptives
• Tricyclic antidepressants
• Digitalis

Healthcare providers must monitor to ensure proper thyroid hormone dosing. Regular medical follow-ups are essential for patients on thyroid therapy.

Treatment for Overdosage

If thyroid hormone overdose is suspected, hospitalization is necessary. Treatment involves temporarily discontinuing the hormone, observation, and support. Most patients require cessation of hormone therapy for 4-8 weeks to enable thyroid recovery. No specific antidotes exist; supportive care is vital. Inducing vomiting is contraindicated due to aspiration risks, and coma cases may need mechanical ventilation. Generally, fluid resuscitation and oxygen administration are sufficient, with possible beta-blockers to reduce sympathetic activity.

Dosage

Liothyronine is available as a daily oral tablet, with dosing tailored to hypothyroidism severity. Therapy should commence with the lowest possible dose due to rapid action onset. The initial dose of Cytomel is 5 mcg/day, increased cautiously by no more than 5 mcg every 2-3 weeks. High starting doses can exacerbate preexisting heart conditions. Typically, 50-75 ug/day suffices, with intravenous options available for severe cases like myxedema coma, a critical complication of hypothyroidism more prevalent in older women.

Liothyronine comes in 5, 25, and 50 ug tablets, and a prescription is mandatory in the USA.