From the FDA Drug Label
The dosage of thyroid hormones is determined by the indication and must in every case be individualized according to patient response and laboratory findings. Mild Hypothyroidism Recommended starting dosage is 25 mcg daily.
The recommended starting dose of liothyronine (T3) for adults with mild hypothyroidism is 25 mcg daily 1.
- Daily dosage may be increased by up to 25 mcg every 1 or 2 weeks.
- Usual maintenance dose is 25 to 75 mcg daily.
From the Research
The recommended starting dose of liothyronine (T3) for adults with hypothyroidism is typically 25 micrograms (mcg) daily, as suggested by recent clinical guidelines and expert consensus 2. This dose should be initiated at a low level and gradually increased based on clinical response and laboratory values. For elderly patients or those with cardiovascular disease, a lower starting dose of 5-12.5 mcg daily is advised. The medication should be taken in the morning on an empty stomach, at least 30 minutes before eating, to ensure optimal absorption. Dose adjustments should occur no more frequently than every 1-2 weeks, with laboratory monitoring of thyroid function tests (TSH, free T3) to guide titration. Liothyronine has a shorter half-life than levothyroxine (T4), so some patients may benefit from divided dosing (twice daily) to maintain stable hormone levels throughout the day. It's essential to note that liothyronine is not typically used as first-line therapy for hypothyroidism; levothyroxine is the standard treatment, and liothyronine is generally reserved for specific situations such as myxedema coma (where rapid action is needed) or as adjunctive therapy in patients who don't respond adequately to levothyroxine alone 3. When considering the use of liothyronine, it's crucial to weigh the potential benefits against the risks and to carefully monitor patients for adverse effects, as the long-term safety of combination therapy is not well established 3. In clinical practice, the management of hypothyroidism with combination thyroxine (T4) and triiodothyronine (T3) hormone replacement should be guided by expert recommendations and individualized to each patient's needs 3.
Some key points to consider when initiating liothyronine therapy include:
- Starting with a low dose and gradually increasing as needed
- Monitoring thyroid function tests regularly to guide dose adjustments
- Being aware of the potential for adverse effects, particularly in elderly patients or those with cardiovascular disease
- Considering the use of divided dosing to maintain stable hormone levels throughout the day
- Ensuring that patients understand the potential risks and benefits of combination therapy and provide informed consent before initiating treatment 2, 3.
Overall, the use of liothyronine in the treatment of hypothyroidism should be approached with caution and careful consideration of the individual patient's needs and circumstances.