Liothyronine – Cytomel
Thyroid hormones are naturally produced in the body, but many pharmaceutical companies offer synthetic versions. The primary types are T4 (levothyroxine) and T3 (liothyronine), both synthesized and stored in the thyroid gland.
Thyroid hormones from pharmaceuticals come in two forms: derived from animal glands (bovine or ovine) or synthetically created. In the United States, the iodine content in these preparations is strictly regulated.
Cytomel (liothyronine sodium) is offered in tablet form and is a salt of a naturally occurring thyroid hormone. T3 is significantly more potent than T4.
Pharmacology
The exact mechanisms of thyroid hormones remain unclear, but their actions promote numerous biochemical changes in cells. They provide energy by boosting the metabolism of carbohydrates, lipids, and proteins while increasing oxygen consumption. Generally, individuals taking thyroid hormone experience a heightened basal metabolic rate. The vital importance of these hormones is evident in patients suffering from deficiencies.
Dosage
Thyroid hormone is rapidly absorbed from the stomach into the bloodstream, with onset of action occurring within hours, though peak activity may take several days. It typically remains in the body for days, binding to albumin in the bloodstream, which protects it from liver breakdown.
Indications for thyroid hormone include:
- Replacement therapy for hypothyroidism.
- Replacement therapy post-thyroidectomy.
- Treatment for goiters and thyroid nodules.
- Diagnostic use in suppression tests for suspected hyperthyroidism.
- Alternatives for patients allergic to pork or beef thyroid.
Body Builders and Weight Loss
For years, both amateur and professional athletes have misused thyroid hormone to facilitate weight loss. The fat-combusting effects of thyroid hormones have been harnessed to improve athletic performance. Cytomel is commonly used across various sports disciplines, often taken orally for 4–6 weeks, discontinued just a week before events. Numerous athletes testify to its effectiveness as a fat burner that boosts energy levels.
However, the complexities arise since many athletes combine Cytomel with various other supplements and hormones.
Online sellers recommend starting Cytomel at 25 µg/day for a few weeks, gradually increasing by 5-10 µg/day. The maximum dose without side effects is approximately 100 µg/day, with anecdotal evidence suggesting 6–12 weeks for effective weight loss. It’s critical users understand the potential thyroid insufficiency resulting from stopping Cytomel, as it can suppress natural hormone production.
It is highly advised that anyone considering off-label use of thyroid hormone for weight loss consult a physician for safety.
Signs and Symptoms
Excessive thyroid hormone can lead to a variety of side effects, including:
- Headaches
- Mood changes — irritability, anxiety
- Excessive sweating
- Irregular heart rhythms
- Palpitations
- Chest pain
- Diarrhea
- Menstrual irregularities
- Exacerbation of heart failure
- Shock
Severe overdosage may mimic symptoms of thyroid storm, while chronic high dosages could result in hyperthyroidism symptoms.
Contraindications
Thyroid hormone is generally contraindicated for individuals with untreated adrenal insufficiency, thyrotoxicosis, or known hypersensitivity. Confirmed allergic reactions to liothyronine are rare.
Signs and Symptoms
Many use thyroid hormone for weight loss, often combining it with other supplements. Therapeutic doses are typically ineffective for weight loss; larger doses may be necessary, but these can pose serious risks, especially when mixed with agents like ephedrine or growth hormone.
Caution is warranted in patients with specific medical conditions as thyroid hormone can worsen adrenal insufficiency, diabetes mellitus, and increase sensitivity to anticoagulants, heightening bleeding risks.
Thyroid hormone is also suggested for infertility treatment, yet no scientific evidence supports this use.
Thyroid hormones should not be underestimated, as they can lead to significant side effects. Individuals with heart issues or chest pain should seek medical advice before starting therapy, opting for the lowest effective dose.
Levels
Levels of thyroid hormone can be assessed easily. All major sporting organizations, including the IOC and WADA, routinely monitor athletes for thyroid hormone presence using sensitive radioimmunoassays that detect trace amounts in urine.
Drug Interactions
Liothyronine interacts with several drug classes, including:
- Oral anticoagulants
- Insulin or oral hypoglycemics
- Cholestyramine
- Estrogens, oral contraceptives
- Tricyclic antidepressants
- Digitalis
Healthcare providers are responsible for ensuring thyroid hormone dosages remain safe. Regular patient follow-ups are crucial.
Treatment of Overdosage
If an overdose of thyroid hormone is suspected, the patient should be hospitalized, and the medication temporarily halted. Monitoring and supportive care are essential, typically requiring a cessation of the hormone for at least 4–8 weeks for gland recovery. No specific antidotes exist, and aspiration prevention is critical; in coma cases, mechanical ventilation may be necessary in ICU. Usually, fluid resuscitation and oxygen are adequate, though beta-blockers may be indicated in some instances.
Dosage
Liothyronine is administered once daily, with dosage tailored to hypothyroidism severity. Treatment should commence with the lowest dose due to its rapid action onset. The initial dosing of Cytomel is 5 µg/day, increasing in increments of 5 µg every 2–3 weeks. Higher initial doses can worsen any pre-existing heart conditions. Most cases require a daily dose of 50–75 µg. An intravenous formulation may be used, particularly for myxedema coma, a severe complication of hypothyroidism, chiefly seen in elderly women.
Liothyronine tablets are available in 5, 25, and 50 µg doses. In the USA, a physician’s prescription is necessary for liothyronine.
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