61-90mg up to 1 1/2 grain
61-90mg up to 1 1/2 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 preparation represents a compounded thyroid hormone formulation dosed in the range of 61–90 mg (up to one and one-half grains), providing T4 and T3 proportional to the established ratio of approximately 38 mcg T4 and 9 mcg T3 per 60 mg grain. This dose range spans from the upper lower-maintenance range to mid-maintenance dosing for most adults. 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) ~38–57 mcg (proportional to ordered strength) | Prohormone thyroid hormone converted peripherally to active T3; activates nuclear TRα/TRβ receptors to regulate basal metabolic rate, thermogenesis, cardiac chronotropy, and protein synthesis. |
| Liothyronine (T3) ~9–13.5 mcg (proportional to ordered strength) | Active thyroid hormone with direct, high-affinity nuclear receptor binding, providing immediate and potent thyromimetic effects without dependence on peripheral conversion. |
Oral administration (capsule or tablet) on an empty stomach, 30–60 minutes before the first meal of the day.
- Swallow whole with water; do not chew or crush.
- Separate from calcium, iron, antacids, and cholestyramine by at least 4 hours.
The 61–90 mg range is a mid-maintenance dose for most patients with established hypothyroidism:
- Many adults reach this range after titrating up from the standard 30 mg starting dose.
- At 90 mg (1½ grains), patients receive approximately 57 mcg T4 and 13.5 mcg T3 per day — still within the typical maintenance range (60–120 mg/day for most patients).
- TSH, free T4, and free T3 should be assessed 4–6 weeks after reaching any dose in this range.
- All dosing is prescriber-determined.
- Levothyroxine (T4): Undergoes deiodination to T3; T3 binds TRα/TRβ and modulates transcription of genes governing thermogenesis, cardiac rate, nitrogen metabolism, and growth.
- Liothyronine (T3): Direct nuclear receptor agonist producing rapid thyromimetic effects approximately four times more potent per microgram than T4.
Doses in the 61–90 mg range represent mid-maintenance thyroid hormone therapy, used in:
- Adults with primary hypothyroidism who have completed initial titration.
- Patients with partial thyroid gland function in whom full suppression is not required.
- Monitoring: TSH and free thyroid hormones every 4–6 weeks during titration; annually when stable at target. Target TSH is typically 0.5–2.5 mIU/L but is individually determined.
- Assess for signs of over- or under-replacement at each clinical visit.
Contraindications:
- Untreated adrenal insufficiency; active thyrotoxicosis; acute MI; hypersensitivity.
Warnings & Precautions:
- Cardiovascular monitoring warranted, especially at higher doses approaching 90 mg, in elderly and cardiac patients.
- Bone mineral density: TSH suppression below 0.1 mIU/L associated with increased fracture risk with long-term use.
- Hold biotin ≥48 hours before thyroid function labs.
Drug Interactions:
- Warfarin: enhanced anticoagulant effect; monitor INR.
- Calcium, iron, antacids: impair absorption; separate ≥4 hours.
- Beta-blockers: may mask tachycardia, the primary sign of thyroid hormone excess.
Common Side Effects: At supratherapeutic levels — palpitations, tachycardia, tremor, excessive sweating, heat intolerance, weight loss, insomnia, diarrhea.
Store at room temperature (15–25°C), in a dry, dark location. Keep container tightly sealed. Protect from heat and humidity. Keep out of reach of children. Use before the beyond-use date labeled by Genesis Compounding.
What range of T4 and T3 does this dose provide?
At 61–90 mg, you are receiving approximately 38–57 mcg of T4 and 9–13.5 mcg of T3 per day, proportional to the standard thyroid hormone grain ratio. Your exact dose within this range is specified on your prescription label.
How is this dose determined?
Your prescriber calculates your dose based on body weight, degree of hypothyroidism, TSH/free T4/free T3 lab results, and your symptomatic response. Titration from the starting dose typically occurs in 15 mg increments every 2–3 weeks.
Is this dose safe for long-term use?
When properly managed and monitored, thyroid hormone replacement is safe for long-term use. Regular lab monitoring prevents both under- and over-treatment.
Is this preparation FDA-approved?
No. This is a patient-specific, 503A compounded preparation from Genesis Compounding and is not FDA-approved as a finished drug product.
What symptoms suggest my dose is too high?
Palpitations, tremor, excessive sweating, heat intolerance, weight loss, insomnia, and diarrhea may indicate supratherapeutic dosing. Contact your prescriber if you experience any of these.
Clinical References
Authoritative sources reviewed in preparing this clinical summary. Provided for prescriber reference; not a substitute for the prescriber’s clinical judgment.