120mg / 2 grain
120mg / 2 grain is a prescriber-directed compounded preparation prepared or dispensed for patient-specific use within the Hormone Optimization therapy area. Genesis should dispense this medication only pursuant to a valid prescription and the prescriber's clinical judgment.
This is a compounded thyroid hormone preparation dosed at 120 mg (2 grains), providing approximately 76 mcg levothyroxine (T4) and 18 mcg liothyronine (T3) — consistent with the established T4/T3 ratio of 38 mcg T4 and 9 mcg T3 per 60 mg grain. This mid-to-upper maintenance-range strength is appropriate for patients with established hypothyroidism whose dose has been titrated to this level. Genesis Compounding prepares this as a patient-specific, prescriber-directed 503A preparation; it is not FDA-approved as a compounded preparation.
| Active Ingredient | Pharmacologic Role |
|---|---|
| Levothyroxine (T4) ~76 mcg per 120 mg (2 grain) | Synthetic thyroxine serves as the primary thyroid hormone reserve, undergoing peripheral deiodination to the active T3 and directly mediating thyroid hormone receptor-dependent regulation of metabolism and organ function. |
| Liothyronine (T3) ~18 mcg per 120 mg (2 grain) | Active triiodothyronine directly binds nuclear thyroid hormone receptors with high affinity, producing rapid and potent metabolic, cardiovascular, and thermogenic effects. |
Oral administration, typically capsule or tablet form.
- Administer 30–60 minutes before the first meal of the day on an empty stomach.
- Swallow whole with an adequate amount of water.
- Separate from calcium supplements, iron preparations, antacids, sucralfate, and cholestyramine by at least 4 hours.
At 120 mg (2 grains), this is a mid-range maintenance dose. Standard dosing context:
- Most patients with primary hypothyroidism require 60–120 mg/day as a maintenance dose; 120 mg represents the upper end of the typical range.
- Dose is reached by titration from a starting dose of 15–30 mg, increasing by 15 mg increments every 2–3 weeks as tolerated and guided by labs.
- TSH, free T4, and free T3 should be reassessed 4–6 weeks after reaching this dose.
- Final dosing is prescriber-determined based on individual patient response and laboratory values.
- Levothyroxine (T4): Peripherally converted to T3 by iodothyronine deiodinases; T3 binds TRα and TRβ nuclear receptors, modulating transcription of metabolic, cardiac, and developmental gene networks.
- Liothyronine (T3): Directly occupies thyroid hormone nuclear receptors, with approximately four-fold greater potency than T4, providing both rapid and sustained thyromimetic activity.
The 120 mg (2 grain) dose is used in established hypothyroidism management for patients who have been titrated to this maintenance level. Clinical considerations include:
- Verify TSH suppression status — at this dose in an average adult, TSH should be within or near the normal range (0.5–2.5 mIU/L is often targeted).
- Patients with residual symptoms despite normal TSH may benefit from measurement of free T3 to assess peripheral conversion adequacy.
- Caution in elderly patients, postmenopausal women (bone loss with TSH suppression), and patients with atrial fibrillation or coronary artery disease.
- Monitor at least annually once stabilized; more frequently after any dose change or intercurrent illness.
Contraindications:
- Untreated adrenal insufficiency.
- Active thyrotoxicosis.
- Acute MI (contraindicated in acute phase).
- Hypersensitivity to components.
Warnings & Precautions:
- Cardiovascular: use cautiously in patients with angina, arrhythmia, or heart failure; excessive T3 may exacerbate cardiac conditions.
- Bone: long-term suppressed TSH associated with reduced bone mineral density.
- Diabetes management: glucose requirements may change with thyroid replacement.
- Biotin interference with thyroid function tests.
Drug Interactions:
- Warfarin: enhanced anticoagulant effect; monitor INR.
- Absorption impairment: calcium, iron, proton pump inhibitors, sucralfate — separate by ≥4 hours.
- Sympathomimetics: concomitant use may increase risk of coronary insufficiency.
Common Side Effects: Palpitations, tachycardia, nervousness, insomnia, sweating, heat intolerance, and weight loss at supratherapeutic doses.
Store at room temperature (15–25°C), protected from light, moisture, and heat. Keep container tightly sealed. Do not store in bathrooms. Keep out of reach of children. Observe the beyond-use date assigned by Genesis Compounding. Discard if the preparation shows any changes in appearance or odor.
What does '2 grain' mean?
One grain equals 60 mg; 2 grains therefore equals 120 mg of compounded thyroid hormone, providing approximately 76 mcg T4 and 18 mcg T3 per dose — amounts equivalent to established commercial desiccated thyroid dosing references.
How is this dose different from a lower strength?
This is a mid-to-upper maintenance dose, typically reached after gradual titration. It is not a starting dose and should only be prescribed once lower doses have been trialed and laboratory goals assessed.
What labs should be checked at this dose?
TSH, free T4, and free T3 should be measured 4–6 weeks after reaching this dose, then at least annually when stable. Hold biotin for ≥48 hours before laboratory draws.
Is this preparation FDA-approved?
No. This is a patient-specific compounded preparation from Genesis Compounding, prepared under 503A regulations, and is not FDA-approved. Prescribers should document the clinical rationale for its use.
Can I split the dose?
Some clinicians prefer twice-daily dosing of T4/T3 combinations to smooth T3 fluctuations. Your prescriber will advise on the appropriate dosing schedule.
Clinical References
Authoritative sources reviewed in preparing this clinical summary. Provided for prescriber reference; not a substitute for the prescriber’s clinical judgment.