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Why T3, or Liothyronine,

is Usually Taken in
Multi-Doses Per Day
28th August 2021 | Paul Robinson (https://paulrobinsonthyroid.com/author/paul-
robinson/) | Thyroid Hormones & Treatment
(https://paulrobinsonthyroid.com/category/thyroid-hormones-treatment/)
T3 (https://paulrobinsonthyroid.com/tag/t3/)
:
This blog post discusses why multi-dosing with T3-
Only or T3-Mostly medication is more effective and
safer for the majority of thyroid patients. It is not
about dosing with mostly T4 medication and a
little added T3. I am talking about full replacement
daily dosages of T3, in the 40-100 mcg per day
region. Smaller amounts of T3 than this are more
easily managed in two doses or even one single
dose per day.
I recently heard of someone who was advocating that thyroid
patients should take all of their T3-Only medication in one single
daily dose. They suggested that this ‘fills the cells and the thyroid
receptors’ so that the T3 is then ‘delivered in waves over 24 hours’.
Dr John C. Lowe was referred to as a possible source of this
‘information’.
I do not believe that this approach would work for most people.

Over the past fifteen years or so, I have

worked with thousands of thyroid
patients on the topic of how to use T3
effectively. Whilst a few of them can
successfully take a single daily dose, the
majority need to multi-dose in some
way.
:
Here is how I came to this conclusion and how and
why multi-dosing can work better for most people.
When I first started on T3-only, I tried taking my 50-mcg daily dose all at once in the
morning. That left me extremely hypothyroid after about 8 hours. Over several weeks, I
tried increasing the dose to make it last longer but I always became hypothyroid within
8-10 hours. It never lasted longer than this. By that stage, I was somewhat expert at
assessing not only my symptoms but also my vital signs of heart rate, blood pressure
and body temperature. So, I could see quite clearly that my metabolism slowed down
after 8-10 hours – it was not my imagination.

In this trial, I continued to increase the total daily dose of T3 from my normal 50 mcg
until I eventually reached about 160 mcg of T3 per day. Two things became apparent:
1) I still became hypothyroid after around 10 hours.
2) I felt hyperthyroid during the early and middle hours. My BP became high, my heart
rate was elevated, my temperature was slightly high and I felt anxious and ill.

The bottom line was that I could find no single daily dose of T3 that either lasted for 24
hours or avoided some element of feeling hyperthyroid at some points and
hypothyroid for a lot of the time.

Dr John Lowe and I discussed this many times. He and I knew each other well. I read his
book The Metabolic Treatment of Fibromyalgia about 6 times and he proofread and
wrote the forward to my first book Recovering with T3. He supported the book and was
going to heavily market it for me in the USA had he not died in an accident. We agreed
on most things and we both saw that there were going to be different groups of people
who would find one form of T3 dosing more effective than another.

John originally believed that, for a lot of people, taking T3 once a day was enough to
provide a large genomic ‘kick’ to the cell nuclei. His view was that this would provide
enough blood levels of T3, and intra-cellular levels, that there would be a T3 supply,
albeit a lot lower than the initial ‘kick’, for long enough to just about get through 24
hours. He never believed that there was any mechanism to deliver T3 in waves over 24-
hours. However, through our discussions, we both came to the conclusion that there
might be different classes of people who have different needs.

The people that John treated were incredibly ill fibromyalgia patients. John himself had
serious genetic resistance to T3 and this ran in his family (it had caused deeply serious
issues for several relatives). However, most people who need T3 do not have such
deeply problematic issues, myself included.

John and I basically reached an agreement that it was fine to have different modalities
of T3 use available to suit everyone. I still believed that the majority of people would be
more safely and more effectively served with 3 to 4 doses of T3 per day. There is no
storage mechanism for T3 to be released in waves or bursts – this is not part of our
physiological design.
:
I believed, and still do believe, that the best way to provide sufficient genomic bursts of
T3 over 24 hours is to use multi-doses. This does not require stable blood levels of T3 in
order to be highly effective. In fact, the free T3 level in the bloodstream can fluctuate
significantly. What counts is whether the genomic activity in the cell nuclei is sustained
at a healthy rate over 24 hours.

My work with thyroid patients makes me very confident in saying that 3 to 4 doses of
T3 over the day suits the majority of patients very well and avoids both hypothyroid
periods and any risk of hyperthyroid episodes. However, I have always believed that
there are some people for whom 2 doses of T3 per day or even 1 dose per day would be
sufficient. We are all different and no one solution works for everyone.

The protocol I developed for using T3 safely and

effectively is described in detail in the Recovering
with T3 book. The book shows thyroid patients and
their doctors how to go about finding the most
effective T3 dosage that is very safe for the
individual. I also discuss the principles behind
multi-dosing.

Here is an extract from Chapter 11 of Recovering

with T3:
How T3 is usually taken each day – divided doses

Someone new to T3 replacement therapy may believe that the

medication can be taken in a single daily dose, just like
synthetic T4. This may work for a few people. However, for most
people, the daily dosage of T3 will need to be split up and
taken in smaller doses, known as divided doses.

This divided dose approach enables T3 to be taken at various

intervals throughout the day, in order to provide a steady
supply of T3 to the body. The use of divided doses also ensures
that no single dose of T3 creates an exceptionally high peak
level of T3 in the tissues of the body. Through the careful use of
:
 divided doses, it is possible to avoid the risk of tissue over-
stimulation by T3 (T3 thyrotoxicosis). Some people refer to the
taking of divided doses as multi- dosing.

In the UK, T3 is only available in 20-microgram tablets.

Unfortunately, this makes matters rather difficult for the
patient.

In order to achieve a divided dose strategy, the UK-based

patient may have to carefully break the tablet in half (to create
two 10-microgram doses), or into quarters (for a 5-microgram
dose). If a 2.5 microgram T3 dose change is required, the tablet
has to be broken up even further, which can be difficult.
In some countries, specialist companies, known as
compounding pharmacies, can produce sustained release T3
for patients. This releases the T3 in a slow way. The idea behind
it is to avoid potential issues caused by large peaks and troughs
in the circulating level of T3 throughout the day. Sustained
release T3 is sometimes referred to as ‘slow release T3’.
However, there are mixed reports concerning sustained release
T3. For those patients who require a full replacement of dosage
of T3, sustained release T3 does not appear to work as well as
pure T3. There may be many reasons for this. It is hard to tailor
a sustained release T3 dose to provide enough T3 for many
hours, without either providing too much, or too little T3, for
some periods of time. This could explain why many of the
patients who have tried to use sustained release T3 have
chosen to go back to using pure T3.

When he initially prescribed T3, my doctor recommended that

I split the daily dosage into two divided doses. I quickly
discovered that two divided doses were not going to provide a
steady enough level of T3 for me during the day. This is just one
example of how limited the existing information on T3 was, as
there were no recommendations to try smaller, more frequent
doses, if the larger, less frequent doses caused side effects.
:
 I have now communicated with many patients who use T3
replacement therapy. There are a small number of patients
who do manage on two divided doses of T3 per day and a very
small number, for whom one large dose of T3 appears to work
perfectly well. However, the vast majority of patients using T3
replacement therapy appear to be using between three and
four divided doses of T3 per day. I have also heard of some
patients who use even higher numbers of divided doses but I
would consider higher numbers of divided doses to be
bordering on impractical.
I cannot emphasise how important it is for many people to
employ T3 in divided doses. For a small proportion of people
one or two divided doses of T3 apparently works very well.
However, the careful use of three to four divided doses of T3
appears to suit many people extremely well.

Over the past fifteen years or so I must have

worked with thousands of thyroid patients on the
topic of how to use T3 effectively. This detailed
experience has not changed my views. I still
strongly believe that the majority of thyroid
patients do better, have more effective results, and
are far more protected from any over-stimulation
and any hyperthyroid symptoms or signs, with
multi-dosing of T3. There are always going to be
exceptions to that and I wrote this in the above
text in my original draft of Recovering with T3 – the
text is still the same as it was back in 2011.
I, personally, have been taking 3 doses of T3 every day for over 25
years now. I have spare T3 tablets in the car and my pocket so that I
:
can take them more or less on time, even if out of the house. It has
become a simple routine, which is easy to remember. I used to put
alarms on my watch/ phone but these are no longer needed
because I remember to take my T3 more or less on time.

I also have a recent blog post that discusses how much T3 is

typically required as a full replacement dose for those people on T3-
Only. It also discusses how much T3 is equivalent to T4 medication
(and how this is not a fixed mathematical ratio). I include this link
because it is so relevant to this post. The two articles form a useful
pair of blog posts. Together, they cover:
1) How much T3 is usually required to provide a full replacement T3
dose.
and
2) Why 3-4 multi-doses of T3 is often the best way for thyroid
patients to take that full replacement dose of T3 (this blog post).
Here is the link to the blog post about T3 to T4 equivalency and how much T3 is often
needed as a full replacement dose:
https://paulrobinsonthyroid.com/pharmaceutical-equivalency-of-levothyroxine-t4-
liothyronine-t3-and-natural-desiccated-thyroid-ndt/
(https://paulrobinsonthyroid.com/pharmaceutical-equivalency-of-levothyroxine-t4-
liothyronine-t3-and-natural-desiccated-thyroid-ndt/)

For completeness, I thought it was appropriate to also include a link to the blog post I
have on Slow-Release T3 vs. Standard T3:
https://paulrobinsonthyroid.com/slow-release-versus-standard-t3-for-thyroid-patient-
treatment/ (https://paulrobinsonthyroid.com/slow-release-versus-standard-t3-for-
thyroid-patient-treatment/)

I hope you find this blog post helpful.

Best wishes,

Paul
:
 Paul Robinson
Paul Robinson is a British author and thyroid patient advocate.
The focus of his books and work is on helping patients recover
from hypothyroidism. Paul has accumulated a wealth of
knowledge on thyroid and adrenal dysfunction and their
treatment. His three books cover all of this.

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