Splitting daily dose of thyroxine into two doses

[AAJS]

Hi, has anybody tried splitting their daily dose of Thyroxine into two doses, half in the morning and the other half later in the day ? I've been thinking about doing it and wondered if anyone else had tried it, and if so how did it work ? Thanks

[Clutter]

AAJS, Thyroxine is T4 which is converted in the liver, kidneys and other organs to the active hormone T3. It;s long acing and takes 7/10 days to build up a store of T4 for conversion to T3. You don't experience spikes and slumps in the same way as if you were taking oral T3 which has a short life of 6/8 hours in the blood so there is no benefit in splitting the daily T4 dose. There is a downside in T4 needs to be taken an hour before or two hours after food and drink or it will bind to proteins which will affect absorption.

[helvella Administrator Thyroid UK]

Agreed with Clutter re finding the slots to take it.

I have read of a few people who do split-dose levothyroxine. At least one felt it helped but most end up reverting to once a day. I suspect that as people stabilise and achieve better base levels of thyroid hormone, the improvement from split dosing is less obvious.

The serum T3 level from taking T4 peaks around 48 hours after taking it. So it is certainly not impossible that split-dosing would be helpful for some.

(I actually rather hope that something like an insulin pump is developed which can squirt T4 and/or T3 into the bloodstream many times a day is developed. That could be set up to provide a pattern of release much closer to our own thyroids when healthy.)

Rod

[rumpie in reply to helvella]

I saw my endocrinologist at Stafford recently and he increased my thyroxine from 500 to 525 daily, split into 250 in the morning and 275mg in the evening - we shall see !

[helvella Administrator Thyroid UK in reply to rumpie]

That is a pretty hefty dose!

For the record, I assume you have tried to think about why you need such a large dose?

(I am well aware that some people do indeed simply seem to need larger-than-usual doses and quite often without ever finding any explanation.)

Rod

[rumpie in reply to helvella]

Thanks for your message regarding large doses of thyroxine - the trouble I have is that I don't absorb it very well. I have had numerous hospital tests and it seems this is the right dose for me at the moment ( I have been as high as 800mg). I am constantly fighting weight gain, hair loss and fatigue .

[NikkiMc in reply to rumpie]

Hi I worked with and Endocrinologist a while ago and he was looking at folks who weren't able to convert T4 to T3 due to having polymorphic gene for converting T4 to T3 - I wonder whether you migth be in that category?

[faith63 in reply to rumpie]

Levo is clearly not working for you, if you have to take a dose that high. Do you have any labs? Curious.

[Anon_77 in reply to rumpie]

Hi just wondering if this splitting dose of T4 still working for you although this is an old post I know but I’ve been considering this and wanting to look into it thanks

[CatSlave]

Hiya,

Keeping Clutter's facts in mind, I can recount my own experience with briefly splitting my dose.

I was on 75mcg levo and taking it at night but still not feeling great. I started self-dosing 100mcg, all at night. Found it was too much. So as an experiment, split the 100 into 50mcg at night, 50 in the morning. The important thing to note about the morning dose is that I intentionally didn't wait after taking it, before having my normal morning coffee.

I felt better doing this: the night time dose wasn't so big it kept me awake as the full 100mcg seemed to do. I realised not long after, through research here, that by taking my coffee right after taking the morning dose, I was unintentionally blocking some absorption of the morning's 50mcg. So all in all I felt better. However I was probably on too high a dose with 100mcg each day, split like this.

At the next bloods, when i fessed up to the 100mcg experiment, GP said I was on too high a dose, agreed to continue to let me have the 50mcg tablets and to continue experimenting. She was, however, adamant that there is no way a split dose would make any difference.

Today, I take my entire dose at night once again. However I alternate 75mcg and 100mcg. I take it all at night only because there seems to be some indication that this is in line with normal body rhythms of T4/T3.

Here's my opinion about split dosing: Don't underestimate the placebo effect. If you feel better doing it, do it unless there is compelling medical evidence that you're causing damage.

Hope this helps.

[shaws Administrator]

I think it would be good if the Endo substituted some of the levothyroxine with T3 and that might be more helpful.