hi I have been on liothyronine only for nearly ... - Thyroid UK

Thyroid UK

139,494 members163,737 posts

hi I have been on liothyronine only for nearly a year . but I am still unsure when to take each dose due to .....

poppppy profile image
20 Replies

i started t3 only with the help of paul Robinsons book so i presumed one took doses spread evenly throughout a certain part of the day . this being from when you awake to about 4.30 - 5 pm . the rationale being the last dose was wearing off before bed so you could have a restful sleep . However after making enquiries with a hospital pharmacy advice line and a liothyronine drug company they so far are telling me that i should spread my doses over a 24 hour period ! as i should be aiming for a steady level of t3 at all times not just concentrating peaks around the day (waking to 430pm as above) . i am now confused because i saw t3 working a bit like insulin does ie you take it and whether you like it or not it does its job . where as people who are not diabetic or hypothyroid and who therefore produce their own insulin /t3 efficiently only do so when they need it . so i presumed that i took t3 only in the day because i would not want the same amount of energy at night as i do want in the day . just like nobody takes insulin before bed ( slow release insulin excepted ) or they would be asking for a hypoglycaemic episode .

basically what i am asking is does t3 get used as A) instant energy whether we like it or not or, B) can this be "stored"/excreted if not needed and only activated to supply energy as needed .

i guess we take t3 to mimic the way a euthyroid person produces and uses t3 . and i know that this is a very complicated process but i suppose i am also wondering if the normal blood range for t3 is the same overnight . did they ever do the tests overnight . because if t3 should be in that range overnight then i should take my t3 spread over the 24 hours .

also i guess we only feel the energy from t3 if our bodies take the t3 into the cells . perhaps this is where the body has some control over what happens to each tablet we take unlike insulin .

btw i am only changing my times because my blood results for t3 were either very high or very low and i felt awful every day on waking for several hours . does anyone know of any research re anything i have mentioned above ? anyone take liothyrionine before bed etc?

Written by
poppppy profile image
poppppy
To view profiles and participate in discussions please or .
Read more about...
20 Replies
shaws profile image
shawsAdministrator

This is an informative link re questions/answers. Dr Lowe recommended patients use once a day dosing within his protocol:-

And finally, why do I specify that the typical patient use one full dose of non-timed-release Cytomel for life? Because extensive testing has shown that this is safe, effective, and most economical—when used within the context of our entire protocol.

web.archive.org/web/2010103...

Hi, The method you are using works for some people, but not for everyone. Many find that taking T3 once a day is what suits them best. Have you tried this method?

Jane x

marram profile image
marram

Nature does not give you a steady dose of T3 all the time, there is a natural circadian rhythm.

If you have been feeling awful when you wake, are you taking it too early? EG, if you usually get up at 7, do you take it at 4.30? I take mine at 5.30 and wake at 6.30, but of course we are all different.

I can't really answer all your questions, but certainly if I am more active my T3 reserves are used up and I get tired, and if I take the T3 and then sit around doing nothing, I start to feel a bit overdosed, have fast heart and generally feel twitchy. This suggests that, like a diabetic, you need to balance output and input more or less consistently.

Do you know if you have adrenal exhaustion, that could also cause problems first thing in the morning. It may be worthwhile doing the following test: Take your blood pressure while sitting down, then take it again standing up. If it goes down when you stand up, that COULD indicate adrenal issues. If it goes up, that is normal and no need to worry.

Hope this is helpful.

Marie XX

poppppy profile image
poppppy in reply to marram

good point thankyou re needing more when more energy expenditure . thankyou . all very informative . by the way had synacthen test . first abnormal so repeated and normal . I wonder therefore which one was the real McCoy . lol

nobodysdriving profile image
nobodysdriving

I suggest you stop looking at your fT3 ranges in the blood, that is not why you feel well or bad.

You are in the right direction to read Paul's books, they offer a lot of useful information and teach you a lot about T3 and your body working together.

HOWEVER we are ALL DIFFERENT, and you should listen to your body first and foremost!

I take my 180mcg of T3 ALL AT ONCE when I wake up in the morning. I used to take it split doses and then started taking it all at once in the night before sleeping, the night time dose gave me TERRIBLE heart pounding so weaned off it and went onto the morning dose, now my heart pounding has gone.

IT was not just the T3 giving me the heart pounding but my unstable blood sugars, so eliminating sugar and grains from my diet has done the final trick.

the company Pfizer (pharmaceutical company) actually advises people on their Patient Information Leaflet to take T3 in ONE DAILY DOSE as it its metabolic effects last up to 60 hours (2.5 days)!!!

here is the leaflet (look under pharmacokinetics and dosage/administration):

labeling.pfizer.com/ShowLab...

BUT I must stress we are indeed all different and many people find multidosing is best for them, the majority of these will find a bedtime dose higher than 5 to 10mcg will cause them 'problems' (ie sleeplessness/heart pounding etc) a few rare people actually benefit from a bedtime dose or a bigger bedtime dose

betty profile image
betty in reply to nobodysdriving

Hi. I can't get the link to open?

Betty

nobodysdriving profile image
nobodysdriving in reply to betty

sorry I don't know why as I can open it with no problems? :(

betty profile image
betty in reply to nobodysdriving

I am using a pc tablet. It says download unsuccessful. I will try on the laptop later. Thanks

Betty

poppppy profile image
poppppy in reply to nobodysdriving

thankyou this is very informative and inspiring . thankyou for thinking of me when you have enough problems of your own x this site has done wonders for me. and I know will continue to do so xx

PinkNinja profile image
PinkNinja

I take mine in 3 doses. I take 50mcg when I get up at 6:30 and have no hyper symptoms. If I took this dose later in the afternoon I get a racing heart which feels uncomfortable so it seems I need most of me T3 in the morning. I then take another 25mcg at lunch time and 25mcg at bed time. If I take it all in the morning I get very tired by mid afternoon and can barely function. Also if I don't take a bed time dose I don't sleep well and I feel very groggy in the morning.

We all seem to be very different. When I was taking 4 equal doses spread throughout the day I had a pounding heart at night and couldn't sleep. Dropping my 4pm dose made me quite hyper so I amalgamated my 4pm dose with my morning dose and that seems better. Neither can I take my entire 100mcg all in one go.

I agree with nobodysdriving that you shouldn't go by your blood levels. They vary far too much on t3 only to be of much use unless you leave the same period of at least 6 hours after your last dose before testing. But even this only gives you an indication of where things have changed and may not tell you anything useful about how well medicated you are, especially if you have any degree of thyroid hormone resistance.

I'm sorry I don't have any research about night time dosing of t3. I only know I sleep better and feel better in the morning if I take some T3 at bed time.

Carolyn x

Clarebear profile image
Clarebear in reply to PinkNinja

Hi Carolyn - are you feeling better on the T3 than you did on NDT? Clare xx

PinkNinja profile image
PinkNinja in reply to Clarebear

Much better thanks. Still trying to find the right dosing schedule but I'm getting nearer :) Reducing my dose was a big mistake. I got very poorly very quickly and it's taken a couple of weeks to get back to normal. I don't have that poisoned feeling I get with T4 and higher doses of NDT which is quite a relief :)

I'm also not needing any of my other medication. Seems I don't have a severe mental illness after all. It was all down to my thyroid!

Carolyn x

Clarebear profile image
Clarebear in reply to PinkNinja

Glad to hear you are feeling so much better :) what a surprise (not) that you don't need any other medication :) xx

nobodysdriving profile image
nobodysdriving in reply to PinkNinja

fantastic update carolyn!!

poppppy profile image
poppppy in reply to PinkNinja

hi thankyou for this . it sounds promising that taking t3 at night stops you from feeling groggy in the morning . the fact that you and others are taking t3 at bedtime and it helps is good news too . so thankyou for sharing with me and good luck and good health . i am still tired on 40mcg a day in 6 hourly doses but I am less groggy I think in the morning . unfortunately blood results is what my endo may be swaye dby . I cant totally say because I have only seen him once so I still remain hopeful . if I change regime like I have how long after should I have a blood test because if its low he may increase my dose as I think I may need . I drew a graph of my dosing now and before taking into account dose peaks 2 to 4 hours post dose and has half its dose left in blood stream 18 hours later and my earlier dosing being all concentrated between waking and 430 meant my blood levels would be higher when blood taken than now on new spread out regime . so I think thats why I am tireder during my waking day . anyway sorry to reply not with just a great big thankyou for your concern but another question . greedy lol

PinkNinja profile image
PinkNinja in reply to poppppy

Unfortunately I don't really know how long you should leave it. I'm not going by blood tests but by how I feel. In my car I think blood tests would confuse things because I don't appear to be a typical patient in that respect.

If you are still tired it could be that you need a higher dose. Typical doses are from 25 g 100mcg so you have plenty of room for an increase of that is what you need.

Sorry I couldn't be more help

Carolyn x

poppppy profile image
poppppy in reply to PinkNinja

thanku xx

humanbean profile image
humanbean

For anyone interested in the circadian rhythm of thyroid hormones, take a look at page 2 of this paper :

press.endocrine.org/doi/pdf...

poppppy profile image
poppppy in reply to humanbean

wow thankyou thankyou and again ty . I just read it and they actually took bloods every 20 mins over 24 hours . drug advice line for company did not tell me about this or give me this advice . this is what I wanted to know exactly . so t3 levels are in euthyroid people normally higher over night . so would you presume then we should mimic this by taking t3 highest dose of the day at night . maybe I am interpreting it wrong but from the graph on page 4 . you see I only take t3 and take in divided doses but looks like a steady state is not what I should aim for but higher dose aiming to peak at 4 a.m so taken around midnight or 0100 a.m or just adjusting all doses to aim for blood levels from each dose (still in the blood stream at half its effect 18 hours later) to give an accumulated higher level overnight . thankyou and do you think I am getting the point . I know there are many other factors to how high my levels are but is this a start

hilary77 profile image
hilary77

Very informative thank you! After I had my thyroidectomy the surgeon put me on T3 only I must admit I felt really, really great on t3 only but my when I saw my endo he said "I was over medicated" and put me on levo & T3, & although I do feel okay & ticking along nicely or should I say I thought I was ticking along nicely, reading this I have realised I am not doing as well as I thought , I am not sleeping properly, I get around 3 - 4 hours of broken sleep a night & come 6 pm I am totally washed out & can barely keep my eyes open, it is as though all my energy has dissipated leaving an empty shell. I checked the link above to Dr Lowes Q & A & did not realise your body doesn't actually need T4, I knew your body converted T4 to T3 but thought you still needed T4 as well as T3, very enlightening. I am going to talk to my GP to see if I can try T3 only, not holding out too much hope as he queried why my endo wanted to check my T3 levels as they didn't matter to thyroid results & I had to enlighten him. They are the ones supposed to be qualified in medicine, not me. I was contemplating going back on NDT & T3 but this may suit me better, if I can get my GP to agree to T3 only.

Thanks again, what a brilliant site & am learning more & more each day.xx

Hilary xx

Not what you're looking for?

You may also like...

Any comments on this Endo?

Having parted ways with a private endo, who thinks I have an anxiety disorder, whilst begrudgingly...

Big girl panties time

ok it's me again but my brain is so confused and foggy right now I just can't think straight in the...

Resent Test Results

Help and thoughts on my test results 5/6/24 - 9-45am Free T4 (fT4) ......

Vegovy

Hi guys, l used to have graves basedow disease and l was waying 56kg which l felt good. Now lve got...

Changing beta blockers

Hello everyone,I have Graves disease and had a thyroidectomy in June 2022.I am on levothyroxine...