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    Hello – Hopefully, you will get some other responses on the Cytomel, but we tend to hear mixed reviews from patients who have tried T3/T4 combination therapy. Some believe that it truly has a positive impact on quality of life. Others found that it brought back a return of their hypERthyroid symptoms, and chose to go back to T4-only therapy.

    The European Thyroid Association put out some guidance last year on combination therapy. They recommend T4-only therapy for at least six months and then if the patient is still not feeling well, ruling out any other conditions that could be causing the symptoms, as well as ensuring that the patient is compliant with dosing guidelines (taking meds consistently on an empty stomach, avoiding soy/calcium/iron within 4 hours, etc.). If the patient is still experiencing symptoms after that time, they recommend a short trial of synthetic T3 (they do *not* recommend Armour or other dessicated products), with a follow up evaluation to see if symptoms improve.