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Optimal Synthroid / Cytomel Combination

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Is taking Synthroid 175 mcg plus Cytomel 5 mcg the same as taking Synthroid 150 mcg plus Cytomel 10 mcg? Which combination should make you have more energy and/or affect your TSH?


Thank you for this question about the dosages of the T3-T4 combo. The numerical equivalent of T3 (cytomel) to T4 (Synthroid or other synthetic/generic thyroxine) is not always what is important. The two dosages that you mentioned are roughly equivalent but some people would do better on the former, and some on the latter. It is very individualized how much T3 vs T4 any one person finds optimal. This is all monitored using trial and error, blood tests, and basal temperature.

One's best energy and best healing can occur at a wide variety of possible combinations, depending on your body's individual needs and how you respond to these different hormones. For this reason, we feel that the art of medicine is reflected in your practitioner's ability to help you navigate carefully. There is no general rule of thumb. We have seen people who do very well with a smaller amount of Cytomel with the amounts of Synthroid you mentioned. We have seen others do better with a much higher amount of Cytomel.

As we've often said, "the proof is in the patient". (August, 2002)

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Dr. Richard Shames has practiced for over 30 years, written and lectured widely on thyroid-related topics, and is considered an expert in the field. He practices in San Rafael, CA. Karilee Shames has been an assistant professor of nursing, and has led thyroid support groups for many years. In addition to writing their popular book, Thyroid Power, they are regular contributors to, and provide a service offering thyroid coaching education sessions to consumers nationwide by telephone. For more information, see their site,

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