Advice please on how best to take a combination of thyroid medication
I'm on a combination of levothyroxine & liothyronine.
How do others manage there combination of meds.
Should i be splitting the dose for best results, take it with food or without.
I would appreciate all advice to see what would give me the most absorption although i must add i'm a little over medicated at the present so i'm gradually lowering the dose of levothyroxine from 150 to 125 micrograms.
Jillymo
Jilly, what dosage of T3 are you taking or planning to take?
On day 24 of 100 mcg T4 + 6.25 mcg T3 at 6 a.m. and 6.25 mcg T3 at 9:30 p.m. (I'm doing it this way because according to the studies on natural circadian rhythm, T3 naturally pulses up at 10 p.m. and starts to go down at 10 a.m. T4 levels don't fluctuate much.) On this dose I don't have fatigue and feel as well at the end of the work day as at the beginning, mentally and cognitively. (Was on 88/18.75 for 7 weeks and didn't feel right. I was taking the T3 every 8 hours at 6.25 mcg per dose. Had tinnitus.)
I'm too sensitive to T3 (as evidenced by the truly adverse reaction when I took 25 mcg in 12.5 mcg evening and morning.....not doing that ever again! Ultra tinnitus: Had a headful of breeding cicadas! Plus so hungry my hands were shaking. Blood sugar took a major dive. For me, at least, less appears to be more. 'Your mileage may vary'. 
)
I'm not wild about T3 but there's apparently conversion issues.
So many on here state they feel better taking T3 so i asked if i could try it, i'm taking liothyroxine 20micrograms.
I have been taking first thing in the morning with my levothyroxine.
I also have the tinnitus it's driving me mad & have the appetite of a horse nothing satisfies me anymore.
I'm slightly over medicated so consultant has told me to cut the levo from 150 to 125.......as yet i cant say T3 is rocking my boat, as for mileage i'm still crawling along. 
i dont know about conversion issues i just seem to have issues......O help.
Jillymo
Maybe try 1/4 of a tablet.
Ironic it is that when I was hypo my appetite was non existent. This stuff is doing nothing good for what used to be my waistline.
The information on T3 is to get HgbA1c tested because it can result in elevated blood sugars. I noticed when I started taking it I was getting instantly high blood sugars (10!!!) from eating a baked potato (never even finished it and the blood sugar was sky rocketing). I had even higher readings in the 12s. Then it seemed to settle down but I also had to modify my diet. When I took the 'big dose' I know my blood sugar bottomed out entirely. My hands were shaking so much I almost couldn't get the food into my mouth. It was just a super exaggerated effect of what T3 is doing to me anyway, which is increasing appetite. I'm not in love with this at all.
I actually felt best during the transition period when I still had the 125 mcg dose floating around and added 5 mcg T3. I got blood taken today and will titrate accordingly depending on. I'd rather be on less T3 and more T4. The problem is the endo has a love affair with TSH. A misplaced love in my opinion. Fortunately I can get around her. I'm just using her blood requisitions to find out what happens when......
Hang on i have lost the plot, by the way love the cat.
You say when you ' were ' Hypo you had no appetite ! So what are you now Hyper ?
No that cant be right your on levo, correct mi if i'm wrong.
I'm now on 125 levo plus 20 mic T3.......no wonder i'm eating like a horse nothing satisfies my hunger, i feel as sick as a parrot if i dont eat something.
That's it T3 is getting the boot. Jillymo
Yes, she's the boss.
Exactly. When I was hypo, I could go all day without eating. Wouldn't set out to do it on purpose but I wouldn't get hungry, just tired.
I'm on 100 mcg Levo and 12.5 mcg T3 and my appetite is still up but not like ravenous husky. Just if I have a choice between 1 slice of rye bread or 2 slices, I go for 2.........which is having a deleterious effect.
That's why I think you should try 1/4 tablet at your current dose or even lower to 100 mcg T4. Then leave it for a few weeks because your tissue stores of T4 are high from the higher T4 dose. The half life of T4 is 6 to 71 days (got that from the Merck website). I know my half life is not 6 days. It's longer than that, maybe even 14 days. Then with adding T3, the cells in the body don't necessarily feel the need to convert stored T4 to T3 at the rate they would if you just reduced your T4 dose and did not add T3. Does that make sense?
This is why when people add T3 they stop taking the higher dose of T4 for several days and then add both the lower dose of T4 and the T3 then. If you suddenly lower T4 from 150 to 125 but add 20 mcg T3, you've just done a megajump in dosage.
Always start smaller than bigger otherwise you won't find your 'sweet spot'. You will just be overwhelmed by the symptoms you are now experiencing.
Adding 20 mcg T3 is like adding anywhere from 60 to 80 mcg T4 but 'instant'. One good thing, if you don't take the T3 for 2 to 3 days, the effect wears off. Then you can start at a much lower dose and see how you feel.
The good thing is you seem to have good absorption of the medication.
Also, it's as if when I was hypo, my nutrient absorption was not as efficient. Now it's ridiculous.
I'll get the results from the bloodwork sometime in the next while (could take a couple of weeks) and then maybe titrate again to 112 mcg T4 and 6.25 mcg T3. Like right now I have some tinnitus. Yesterday I didn't. This is the T3 because I took 6.25 mcg last night at 10 p.m. and another 6.25 mcg an hour ago. I notice that if there's anything that interferes with absorption, like let's say there's still food hanging around in my stomach, the variation in absorption is sufficient to reduce the dose absorbed such that I don't get the tinnitus. Whatever difference it is, it is quite small. But now there's a goodly chorus of cicadas going on. Not as bad as when I took the BIG dose.
My body seems to need a nice dose of T4 because the heart palpitations stopped when the Levo dose went from 112 to 125 even though the fT3 level didn't move. There is a conversion issue that has developed over the years because the 125 mcg dose back 14 years ago gave an fT3 of 4.5 (same range as now) and well, that wasn't stellar either but last year it was 4.1 which was worse.
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Best time to take medication?
I have always taken my dose, whether T4, T3/T4, NDT or T3 only once per day. I have always been advised to take it once per day and it's far more convenient. You have to have an empty stomach as food interferes with the uptake of levo so I take it first thing and don't eat for around an hour. If you take food you have to have two hours gap either side of medication. You have to have a time-table if you split doses and it may not always be convenient. Some take their dose at bedtime not having eaten for 2 hours beforehand.
can I just say to Shaws, I am so glad you have said you take even T3 once a day,
I kept reading about how it should be spaced out during the day and have been feeling awful doing this, when I was taking just 25mcg of Mexican T3, I was ok, but it didn't seem enough, even though I felt ok, mainly because when I was on Levo I was taking 125mcg.
but something must have changed as I took 50mcg split in two doses of T3 yesterday, and had the most awful symptoms of hyper all night.
I would love to know the real strength of the Mexican Cynomel.
When medicating you always go by pulse and symptoms of hyper and reduce dose.
I think the spacing idea came about if you had an adrenal issue which I think Paul Robinson uses.
Also most Endocrinologists use terminology that's wrong, re T3 i.e. short life etc. - that's it's difficult to medicate. I don't think many have a clue how it works and I will link below for info. The idea that, somehow, T3 is dangerous (it is only a synthetic hormone after all) and it may cause problems if taking too much but it's the same with T4 or any medication if we take too much. Excerpt:-
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...
Synthetic T3 being the active hormone, synthetic T4 is supposed to convert to sufficient T3. After a short while in the bloodstream T3 enters the receptor cells and has to saturate the cell in order to send out 'waves' and that lasts between 1 to 3 days."
Dr Lowe was also not in favour of 'time-release' T3. I think the fact that he also used T3 himself, NDT and T3 for patients and was a scientist too he knew more the Endocrinologist who insist on levothyroxine alone.
Of course, some people cannot tolerate some thyroid medication for one reason or another and that's difficult.
Roughly, 25mcg T3 is equal to approx 100mcg levo so 50mcg T3 = 200mcg levo. I find my dose of 30mcg is perfect for me and, compared to levothyroxine which was horrendous, I enjoy my health at present.
Thank you so much Shaws, I agree with everything you say, I have researched as much as possible and it seems we both did the same research etc,
I have seen people say T3 only lasts 4-6 hours, but I have read on DR Lowes writings that it lasts for approx. one and a half to two days, although may not be active that long.
I believe I kept adding to get up to 50mcg when I was over dosing, and I am so grateful for your help, I will go back to my one 25mcg and 10mcg dose, taken in the morning.
I just wanted to say, (no edit button?) it just shows how different we all are, but it is comforting to find someone else on the same page, especially as having to self medicate, so thanks again Shaws.
This new system isn't clear on how we edit, etc. but if you press on the arrowhead on the righthand side of Reply button, click and edit, delete etc appears. The only thing when you edit you are surprised to find about two lines of your post, you then have to put cursor in corner of box and pull it down to enlarge. Good job our medication's working.
Thanks Shaws.
I'm so pleased to hear you have managed to find the correct combination that suits your needs.
It's not that i cant tolerate the medication it just isn't working for me. Is your weight stable now your on the correct dose ?
Jillymo
What medication are you taking? What were your last blood test results?
I am not on a combination just straight T3. I was fortunate not to gain much weight and am much the same weight before diagnosis.
If your doctor doesn't prescribe enough medication for you and keeps your TSH within range rather than low or suppressed your metabolism cannot rise enough in order for you to exercise and diet because it is just fruitless. It is a researched fact that levothyroxine can cause weight gain.
web.archive.org/web/2010103...
web.archive.org/web/2010032...
That is exactly what i have been doing taking first thing in the morning.
You are so right about slitting the dose being inconvenient but some do recommend doing so.
Thank you for your input.