60mg / 1 grain
60mg / 1 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 at 60 mg (1 grain), providing approximately 38 mcg levothyroxine (T4) and 9 mcg liothyronine (T3) — the standard reference quantities for one grain of thyroid hormone. The 60 mg (1 grain) strength represents the lower end of the typical maintenance dose range for adult hypothyroidism management. 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) ~38 mcg per 60 mg (1 grain) | Prohormone T4 undergoes peripheral deiodination to the biologically active T3, which then activates nuclear thyroid hormone receptors (TRα and TRβ) to regulate metabolic rate, thermogenesis, cardiac function, and developmental processes. |
| Liothyronine (T3) ~9 mcg per 60 mg (1 grain) | Active thyroid hormone directly binding TRα/TRβ nuclear receptors with high affinity, producing potent and rapid thyromimetic effects on metabolism, heart rate, and thermogenesis. |
Oral administration (capsule or tablet), taken on an empty stomach 30–60 minutes before the first meal.
- Swallow whole with water.
- Maintain ≥4-hour separation from calcium, iron, antacids, sucralfate, and bile acid sequestrants.
The 60 mg (1 grain) dose is a clinically significant benchmark:
- Represents the lower bound of the typical maintenance range (60–120 mg/day) for most adult patients with primary hypothyroidism.
- May be a sufficient maintenance dose for patients with small body habitus, partial residual thyroid function, or those early in dose titration.
- Titration: standard increments of 15 mg every 2–3 weeks; dose may be adjusted up or down based on TSH, free T4, free T3, and clinical response.
- All dosing decisions are prescriber-determined.
- Levothyroxine (T4): Peripheral conversion to T3 by type 1/type 2 deiodinases; T3 then binds TRα and TRβ and modulates transcription of metabolic, cardiac, and developmental target genes.
- Liothyronine (T3): Direct, high-affinity nuclear receptor agonist producing immediate thyromimetic effects on basal metabolic rate, cardiac chronotropy, and thermogenesis, with approximately four-fold greater potency per microgram than T4.
The 60 mg (1 grain) dose is used in:
- Transition from early titration to initial maintenance in patients with primary hypothyroidism.
- Maintenance dosing in smaller adults and patients with partial thyroid function.
- Provides combined T4/T3 therapy for patients who have not achieved full symptom resolution on levothyroxine monotherapy and are being trialed on combination therapy.
Monitoring: TSH, free T4, and free T3 at 4–6 weeks after reaching this dose, then annually when stable. Hold biotin ≥48 hours before thyroid labs.
Contraindications:
- Untreated adrenal insufficiency; active thyrotoxicosis; acute MI; hypersensitivity to components.
Warnings & Precautions:
- Cardiovascular monitoring, especially in older patients with coronary artery disease risk.
- Biotin assay interference — hold supplements before thyroid labs.
- Adjust diabetes medications as metabolic rate normalizes.
Drug Interactions:
- Warfarin: enhanced anticoagulation; monitor INR during dose changes.
- Calcium, iron, antacids, sucralfate, cholestyramine: impair absorption; separate by ≥4 hours.
Common Side Effects: At supratherapeutic doses — palpitations, tachycardia, tremor, excessive sweating, heat intolerance, insomnia, and unintended weight loss.
Store at room temperature (15–25°C), protected from heat, light, and moisture. Keep tightly closed in original container. Keep out of reach of children. Observe the beyond-use date assigned by Genesis Compounding. Discard after BUD.
Is 1 grain (60 mg) a full dose of thyroid hormone?
For some patients, 60 mg is a sufficient maintenance dose; for others, it is a stepping-stone toward higher maintenance doses of 90–120 mg. Your prescriber will assess your response with lab work to determine if this dose is optimal for you.
When is the best time to take this?
On an empty stomach, 30–60 minutes before your first meal, with a glass of water. Separate from all supplements containing calcium or iron by at least 4 hours.
What lab tests are needed?
TSH, free T4, and free T3 should be checked 4–6 weeks after starting or changing this dose. Annual monitoring is appropriate once you are stable on a consistent dose.
Is this the same as Armour Thyroid?
Compounded T4/T3 preparations use pharmaceutical-grade APIs to provide T4 and T3 in the established grain ratio. They are not the same as manufactured Armour Thyroid and are not FDA-approved as compounded preparations.
What should I watch for after starting this dose?
Signs of too much thyroid hormone include palpitations, rapid heartbeat, tremor, nervousness, excessive sweating, heat intolerance, and insomnia. Report these to your prescriber promptly.
Clinical References
Authoritative sources reviewed in preparing this clinical summary. Provided for prescriber reference; not a substitute for the prescriber’s clinical judgment.