Splitting dose of T4 experiences?

[Clara9]

For those of you who tried.splitying your t4 dose. Did it have any effect and if so what effect?

[tattybogle]

i split levo .... roughly half around 7am / half around 11pm .... not due to any specific effects on my symptoms (although i do think it helps how i feel overall, i think it evened up my energy a bit , i used to crash very badly around 4 pm every day ..... but to be honest it's all a bit subjective... i've been splitting it for many yrs now , and i've no inclination to rock my boat).

I mainly split it just because it's logical ..... if i have half at bedtime , my fT4 levels over the day and night will more closely resemble the natural production from a healthy thyroid , which does not deliver a whole days worth of T4 in one go .. it gives a fairly steady drip feed over the day with slightly more delivered over night / very early hours of the morning .

so.... just in case my body has some clever use for slightly higher T4 / T3 levels at 3/ 4 /5 /6 am ish , i choose to let it have them by taking some at bedtime.

(and on a practical level ... the need an have an empty stomach to take my bedtime dose consistently stops me eating unnecessary malteser's in the evening)

[Clara9 in reply to tattybogle]

Thank you. Did your levels change when you started splitting?

[tattybogle in reply to Clara9]

not possible to say . i have a history of wildly wandering fT4 levels anyway despite being very consistent with last dose / test time etc ... and i have also lowered dose from 125 to 112.5 to 100 just to muddy the waters (due to persistently over range fT4). TSH is significantly higher than it was , but that is most likely due to the lower dose (it used to be stuck at 0.05 ish, now its wandering around between 1.5 -3ish) and fT4 is still over range! lol.

clear as mud .

[Hashihouseman]

Split mine into 3 or even 4 doses.. Taking all at once caused all sorts of perturbation and adverse effects, after 10 years I still cant do it. I am fairly sure from blood tests and extensive trial periods on various dosing regimens that splitting T4 optimises conversions to T3 throughout the body - logical when you consider rate of T3 conversion is reduced by negative feedback from higher/rising levels of fT4 and that the healthy thyroid gland delivers T4 evenly 24/7 NOT all at once at 6am or whenever…

[Clara9 in reply to Hashihouseman]

Thanks. Do you feel any different taking it all at once vs dividing? Does it help with conversion even if ft4 levels stays within range? Do you know where I can read more about this?

[Hashihouseman in reply to Clara9]

So yes i feel much better taking the dose split into 3 or even 4 to minimise the amount each time without getting to he point of taking it every 2 hours which might be even more physiologically natural! Another way to put it is that I feel so bad taking it all at once that it must be wrong! And that never gets any better, after years of 'getting used to' levothyroxine ! Asking whether conversion improves while keeping fT4 in range is a great question because that would indicate the goldilocks point of dosing/replacement where t4 can deliver normal ft3 and ft4 in levothyroxcine only therapy but I have to say that in my experience T4 alone never enables me to reach normal fT3 with normal fT4. The reason may be that I have the gene mutation that reduces t4 -t3 conversion rate/efficiency although I suspect even fully functional conversion gets screwed up by levothyroxine dosing regimens. .... Anyway, for me i can say that fT3 levels are better with levothyroxine only if I split the dose BUT they are still too low so there is a tendency to keep pushing T4 to levels where fT4 is dangerously high (risk of acute negative feedback on t4-t3 conversion and atrial fibrilation. I have had to resort to T3 &T4 treatment, splitting doses of both into three and this enables perfectly normal blood levels of fT3&4. That said even then I have slight hypothyroid symptoms remaining and they seem to be ameliorated only by running fT4 at slightly above normal b ut avoiding upper range normal because the data shows there is still an increase in risk of Afib with fT4 levels at the upper end of the so called normal lab range, which sadly means the ill-informed members of the medical profession think its ok to leave treatment at that level, it probably isnt! As to further reading, I would say its everywhere and anything you can find on thyroid hormone metabolism and papers indicating normal healthy levels and correlation with adverse outcomes plus of course your own unique experience where frequent blood testing and symptom and dosing diary are vitally important.

[adin]

I split mine in two but I take lio-T3 also with it....

[Clara9 in reply to adin]

What times do you take them and what doses?

[adin in reply to Clara9]

the first is the big one(100mcglevo+12 T3 slow release form) in the morning at 07 am and the second (25levo+5T3 srls) in the afternoon and another 5 T3 at 6pm