I posted a few questions the other day about my T3 addition but no one responded. So let me try this question. I am extremely sensitive to meds, especially new add ons. Dr prescribed at my request T3 Generic for Cytomel. She wanted 5mcg once daily and drop then my synthroid dose. Question is...... i started by a quarter pill in the morning for a few days and now i added a quarter in the afternoon. so far so good. I am going to wait a little to let my body adjust then I was wondering should i start doing a half morning and then add a half in the afternoon after a few days? (totaling 2.5 morning/2.5afternoon) or is it better doing a quarter pill 4 times a day to prevent palpitations and insomnia? I know you all are laughing right now , but i am serious about how sensitive I am. A few yrs ago before i knew about the hashi's and they just diagnosed me with the usual anxiety/depression because no one checked my thyroid panel or antibodies they put me on SSRis and benzos! Yuck! I started the smallest dose of celexa 10 mg and got so sick i had to break it in half!!!! Yes Hslf of the minimum dose. I want to prevent getting so super sick and/or the tremors/shakes that T3 can give you. I am just feeling this out yet. I really don't know if T3 added in with my synthroid is even the correct answer yet it is too soon. I do know i had terrible joint pain on T4 only that is gone now so far. Hair still falling out but I have more energy already, just no weight loss yet. Any advice welcomed please!
T3 two times a day or more?: I posted a few... - Thyroid UK
T3 two times a day or more?
Sorry no one commented...
I would read Paul Robinsons book called Living with T3. He has Hashi. He also has a website and is on face book. There s a T3 support group. If you google you will find. The book is a bit intense but is a useful resource and covers vitamins etc too.
As you say you are very sensitive -so it seems wise to proceed cautiously as you are. It might be once you have a little more in your system and your body is starting to respond you can increase with a slightly bigger increase. However to be honest what matters is what works for you. If going up in tiny steps works then thats the way I would go. We are all different and half the battle is learning to listen to your body. Just keep an eye on your blood levels too through periodic tests/checks.
I would also make sure you are optimal on the usual -B12, vitD, folate and iron.
I am not sensitive to T3 yet I dose 4 times a day. It just seems more natural. 6 am, 10 am, 2 pm and 6 pm. If I wake late, I just dose every 4 hours upon waking. I would add extra just as you described. Good luck!
abewitched1 i read depending on if you have adrenal fatigue or if it is a conversion issue should determine if we need a multiple dosing or 1 time a day. Do you know about that?
My only knowledge of adrenal fatigue and T3 dosing is the circadian method where you wake up early in the morning and take your first dose and then go back to sleep. Then you dose 4 hours later and so on. Everyone is different and it depends on how your body is using the T3 up. Most of what I've researched in the last 5 years says you do better with multiple doses. It's not a storage hormone like T4 or NDT and your body uses it up rather quickly (half life is only a few hours). Also I have no issues at all taking my T3 with food. Most research says it's not affected by food (only calcium and iron) Dosing with T3 is very trial and error for me. You can really only go by how YOU feel.
thanks abewitched1 yes i am finding this out lol
I have Hypothyroidism and Addisons disease my adrenal glands do not work so I live in hydrocortisone and fludricortisone. I'm interested in this discussion about T3 as Addisons causes severe fatigue I recently talked to my Endocrinologist about T3 possibly helping my energy level and insomnia and she shot me down in flames saying the feeling of well being is very short lived and studies showed after a year of being on it there was no actual benefit. I've no idea if she's right or not as i got the idea of T3 supplement on top of my Thyroxine on here. 😨
The usual treatment in UK is to spread the steroid replacement throughout the day into 3 doses trying to mimic the bodies circadian rhythm. It's not anywhere near what the body would naturally do but it's better to spread usual meds in small doses.
* I should point out Adrenal fatigue and Adrenal Insufficiency are 2 different things . Addisons is very chronic life threatening disease and not repairable Adrenal Insufficiency whereas Adrenal Fatigue can be helped .
yes waveylines i always keep a close eye on my nutritional levels. Thank you for this. I was wary about the anxious side effects of T3 but so far so good. I will look into this book.
Twice a day should be fine. It is better to take the second dose before bedtime as the brain needs adequate hormone for good quality sleep. If this causes insomnia you are clearly on too much thyroid hormone.
HASHImom,
Sorry nobody answered your previous questions.. Weekends are better to post because there are more members about.
How each of our bodies tolerate a new med is very individual and I suspect based on how long we were left undiagnosed for. I know the hormones & supplements I most required were the ones most difficult to introduce.
I introduced 5mcg T3 weekly at a time but you can do 2.5mcg T3 if you are happier but leave each increment for a week to ensure there are no unwanted effects and don't suddenly jump to a higher amount just because you are feeling the good effects.
As long as the total amount of T3 & T4 doesn't exceed the amount of T4 you were originally medicating, you are fine (T3 is 3 x more powerful than T4).. You can take it in four daily doses if you feel more confident but remember there must be no interaction with foods or other meds and sometimes this can be difficult to avoid when dosing so frequently. I tried three times a day for a while and honestly felt no difference so have resumed to twice a day which is more manageable.
I initially had big improvements when I started on T3 and they continued for a year, when I then felt well enough to switch to NDT, having addressed nutrient deficiencies, iron overload & gut issues. I am still feeling improvements now and think sometimes we forget how ill we had become.
My BP is slightly high but I don't medicate anything for it and my heart used to jump about all the time when medicating only Levo but stopped (jumping, not beating ! ) the day after I introduced T3. I have had no troubles since but still have slightly high BP..
I know stress still gives me brain fog so I write everything down as a plan. It is a good idea to work out your plan regarding introducing frequency & dose changes beforehand and then if you feel brain foggy, you will have it to refer to.
Have confidence HASHImom. Good luck.
Slow & low is the way to go.
Rad thanks a bunch! I just want my life back. I understand i may never be thin again, but i so want some of this weight to come off. Hopng once i get to the whole 5mcg a day maybe it will help. The good news is just from starting the T3 i am feeling better already and exercising again. Not just a slow walk every day. I will play around with what works best for me as you said. My BP went up a bit but i guess maybe that is good in my case since i had hypotension.
When I was taking T3 with thyroxine, I found it better to take tiny amounts throughout the day, but for me 4pm was a cut off time as I couldnt sleep if I took any after 4pm.
yes Beverleyb i was afraid of the insomnia. The first few days i only did a small dose in the morning and watched how it went then introduced the same small amount 6-7 hrs later so that it was still super early. I hate insomnia!!
I have never taken T3 later than 4pm myself but some members find it beneficial to dose before bedtime as T3 helps them sleep.
I sleep well (now) anyway (thank goodness).
I am not sure what to say about the T3 because it's unclear how much you are reducing your Synthroid. But, I belong to a Facebook group called FTPO-thyroid issues. There are several groups under the same FTPO, including one for Hashi's people. Google it, be sure to put in Facebook in your search and post your question there. The admins of these groups are really helpful and everyone shares their experience so I am positive you will get a good answer. I have learned so much from following them and reading others questions! I do know that they follow the protocol from the book titled STTM -stop the thyroid madness. It's a great book if you want to learn more! In most cases the recommended starting dose for T3 is 20 mcg. But with your sensitivity issue I know you need to be careful. I hope this is helpful.
Sylvrfox ido know about that author/dr and have heard about the book. I would love to read it. I have read articles by her, Izabella wentz and Dr. Brownstein as well. They are very good! I was upped from 50 synthroid to alternating 50-75 because i was having hypo symptoms and my TSH was climbing. When i finally got the new endo to prescribe T3 she would only give 5mcg daily and she suggested dropped to 50 synthroid which i did but thought i should not have since it was such a small amount. Thank you for this reply i will look into these groups for sure. I read a lot from Hypothryoid mom Canadian who has given me a lot of info.
It's good to know you are familiar with Dr. Wentz and Brownstein, they are well informed and a good source of information. Do get the STTM book, there is a second addition out as well, I have it but haven't read it yet. I agree with you that dropping the Synthroid by 25 is a lot when only adding 5 mcg of T3. I wonder what the reasoning is behind that? You might try adding 5 mcg. Every 5 days until you are up to 20 if you are going to drop 25 mg. of Synthroid. I have to warn you that the FTPO group is biased against Synthroid, as am I, for most hypo patients. I think some Hashi's do ok on it but the general feeling is that most do better on natural dessicated thyroid formulas. Good luck!
You're welcome HASHISmom34,, I hope it all works out.
I meant to say that i split my ndt into three doses per day. First thing in the morning, mid day, and a very small dose before bed. My endocrinologst told me that T3 is at its most active for five hours. So be careful how big a dose you take at night or it can keep you awake. I stack mine sothe bulk of my daily dose is taken in the morning and lunchtime. There is no set way to take it as its what works for you. Some people split their T3/NDT more but I know of one person who takes the whole daily dose of t3 in the morning on waking and is fine!!
when the dr said once when i wake i thought HUH? not what i read, but some have mentioned a dr. Lowe who suggest that is best!
Yeah hashimom I think it depends how your sytem currently is and what part has become defunct. There was an interesting piece of research (sorry cant reference it as cant remember its title lol!) recently with a theory of mutiple layers showing that it is not a simple TSH to T4 straight feedback loop as has been believed for many years. This might explain why there is such a wide varience on what works. So who knows in the future they may find out more....then we wont be thought nuts for not conforming to mainstream meds.
I thought I'd share my experiences with you since we are all different and maybe something I say will apply to you. When you say you are sensitive to meds, I'm not, but as little as 2.5mcg of T3 can mean the difference between me sleeping and not sleeping at all! So, maybe you and I are rare, or maybe not. But you're not alone 
Also, I tried straight T3 as it was supposed to be the best for me since I have thyroid hormone resistance. However, on a whim (because I was still feeling unwell) I tried the slow-release and it, so far, has been fantastic. This is the best I've felt since Hashi's stole my body 6 years ago. You may want to look into 2.5, 5, or 10mcg capsules as they slowly release over a period of 6 - 8 hours. As it's a smaller amount throughout the day, it may suit you better with your sensitivity. Also, I'm not sure if this will happen to you as you're still on T4 as well, but after about 9 weeks of only using T3, my RT3 and T4 cleared, so I had a couple days of being really hyper. After that, I dropped my T3 dose down and slowly raised it to try to find the right dose for me. Most people slowly clear RT3, so an adjustment may need to be made in 8 - 12 weeks of starting it.
bunnywhisperer hello. When you say your T4 and reverse3 cleared what did you mean? i don't follow. For quite some time mine was very up and down (TSH) and my Free T4 and Free T3 were barely in lab range, like on the line of drooping below. No matter the dose of levo (T4) my free T4 started to go slowly up but my T3 did not budge and that is why i went after cytomel. I was misdiagnosed for at least 12 yrs. since my first child was born, The new dr thinks possibly i even had issues prior and that is why i never had a regular menustral cycle since it started. I don't know. Sometimes my memory is so bad or i lose my train of thought so often i think i am developing dementia or alzheimers at 35! I am extremely sensitive though and like you i think i am going to keep breaking my 5mcg into multiple pieces for now. I am even afraid to take a half at a time lol
Yes!! I was 32/33 and was convinced that I had early onset dementia or Alzheimer's. Sometimes when someone finished a sentence, I couldn't remember the first part of the sentence, so I couldn't grasp what they were saying..no matter how simple it was. It was terrifying. The T4 just didn't agree with me at all. It made me so much worse, rather than better.
If you are on enough T4, but still feeling hypo or other bad symptoms, it could be that you have high reverse T3 (RT3). Another possibility according to Paul Robins, is that the T4 is blocking your T3 absorption. And since your T3 is low (conversion issue?), the little bit you do have may be not be able to be used. So when I stopped all meds containing any T4, at about 9 weeks I had about 1.5 days of feeling super hyper because all my T4 and RT3 had left my body. My heart was racing, I was shaking, nauseous, etc. But, I was SO happy! It was all because of the RT3 & T4 clearing my body, so suddenly I was able to use the T3 that was in my body. When I felt that happy because the T3 was finally in my cells, I realised how unhappy I had gotten - simply because my body couldn't access the T3 and made my mood low. Most people slowly clear the RT3 and T4 and don't have a day of being extremely hyper. A blood test can tell you if your RT3 is high if you wanted to check that. Does that make sense?
As for breaking up the tablets, many moons ago I worked as a technician in a pharmacy, and at that time (it may have changed since then), any thing time-released/sustained-release couldn't be broken up. That destroyed their ability to slowly release correctly. Also, I'm in New Zealand so I'm not sure where you are or how it works there, but I have to have my SR T3 capsules made up at a compounding pharmacy. So, if you want to give them a try, you'd probably need to talk to your doctor about a different prescription for the slow release.
Have you read the book 'Recovering with T3' by Paul Robinson? That may be a good place for you to start. Another idea is to use Google Scholar and search for Dr John Lowe. He did some fantastic work with T3 (he also used it himself) and I have found his work extremely beneficial. However, I have thyroid hormone resistance and he specialised in that. But, he a lot of great research/information about T3 in general. I hope that answers your questions! Please let me know if it's still not clear or if you have any other questions
thank you Bunnywhisperer. I do not think i have hormone resistance. What is google scholar? I am in the US. I will look into both guys and the books. I am on cytomel 5mcg tablets that i have been breaking. I do not think the tablets are slow released or it would specify right? I mean my son had a script we picked up that said on the label that the capsules were slow time released. Unfortunately even though there is a compounding pharmacy up the street I already looked into it for my synthroid and my insurance does not cover compounding.
You can find Google Scholar by typing in 'Google Sholar' in regular google. Here is the link for me but it will be different for you as you are in a different country (but may default to US): scholar.google.co.nz
Yes, they would specify that they are slow-released on the box/bottle. I currently live in New Zealand, but was born and raised in the US and know how rare it is for any meds outside of mainstream to be covered by insurance there. While we have socialised health care here, and have for many years, compounding meds are not covered here either. Nothing except 2 (or 4?) synthetic T4 meds are subsidised for thyroid hormone replacement. It's very expensive, but worth every penny for me. Have you tried contacting the compounding pharmacy and explaining your situation? They are usually used to this as most of their customers are probably in the same boat. They may have grants or other ideas for you.
Thank you for this as it is helpful. Any suggestions are. I will look into everything.
Hello,sorry no-one answered it's quite a complex question! I'm just the same so sensitive to meds! I think it's ok to split your dose into 2 x a day if you can sleep ok? I haven't don't it myself because I take Erfa thyroid which is an NDT which has both T3 and T4 in it,I know now that I can't function without T3! Everyone is different and it's sometimes hard to find what's right for your body! Have you had your RT4 and RT3 tested? It's a test to see how your converting! I don't know if they do this test in the UK? I live in Belgium now.
Are you on any supplements? And have you had your adrenals checked?
Hope I was of some help? You will get there in the end
Big hugs stephanie
zorrogirl yes my adrenals were ok but on the higher range end but they did blood not saliva. My nutrients are good and i test them. I had my reverse 3 done once at my request months ago and it was in range. I am sleeping ok. the only time i didm;t is when i first started on T4 only ad they started me on way too mud to start and I went from improving right to hyper. I am an American in the US. Drs are difficult here and many do not know anything about thyroid and not much about auto immune disease.
In range doesn't mean it's ok!? Most doctors say that when your in range could be too low for you! My other doctor said everything is in range then when I found a specialist doctor he said everything is out of range for someone with hashimotos! I'm on another site too called hashimotos 411 from the US maybe someone can help you find a good doctor? Good luck
I have been fighting the thyroid since my teen years. Started over active then at 45 reversed to under active and the weight poured on. Have been fighting the weight without success. Joined weight watchers and so far so good. Hoping to keep it up. Energy is so much better.
keep going with what works for you!!! thanks BOnnieT
I'm on T3 since late last year. Weaned on gradually and got rid of T4. At each appts Endo looked at bloods to judge room to tweak. Up to last was on 40 daily, 20 and 20.
I'd lost 11 lbs very pleased but was suffering from heat and bad week previously.
Had gone over optimal dose.
Now on 30 daily and told to try a MONTH on 20 and 10 and a month on the on 10, 10 and 10. and take stock of how I was doing at end of each month to see if one suited best. I could choose which way to try first.
I was so relieved to have this option as I felt next choice at was continue on T3 or go for NDT. The dose of 40 had pushed me too far and my mind was all stressy you again, plus the heat. I am near end of 20 and 10 and back to 'my' normal which is way better than T4 but not as I was.
Sorry to ramble...
Now about to go for 10 10 and 10!
Will likely be going down NDT at next. Have to try though will have to pay. On free T3 for now on nhs. Endo disappointed at nhs not wanting it on nhs...
I don't know if T3 only is an option for me.
I used to be similarly hyper-sensitive. Now that I am well, I am pretty sure my sensitivity was the combination of Hashimoto's, nutritional deficiencies, and adrenal dysfunction. Is your doctor dealing with any of those things? Regarding Hashi's, most doctors are clueless about environmental health issues; you might see if you can get a copy of the book by Izabella Wentz.
It sounds like you are moving toward T3-only therapy. When I was on T3-only (a little over a year), I used five 12.5mcg doses of Cytomel spread out over the waking day. The dosing schedule was a nuisance, but T3-only worked well for me. I concluded that my T3 full replacement dose was about 0.82mcg/kg body weight. I suspect that 5mcg T3 is way below the dose you will require to become euthyroid.
I would be afraid to go T3 only as I think by my labs i need both. I read a lot from author and dr izabella wentz and dr brownstein as well. I definitely feel much better with the cytomel generic added to the synthroid brand than synthroid alone. And the levo (generic T4 ) was awful for me. No vitamins are deficient here. I have raised mine and working on getting them to top range. I take ashwagandha for adrenals.
Using T3-only IS a nuisance cuz you constantly have to be dosing. I mistakenly interpreted "drop synthroid dose" as discontinue, not reduce!
From a practical point of view my experience is twice daily is OK and you are less likely to forget a dose. I can understand a desire to compensate for the short elimination half life of T3 by multiple dosing but if you were to do this how do you maintain steady levels overnight? The above protocol is daylight orientated!
One point usually missed, especially by doctors, is that T3 takes time to enter the cells and several hours to activate the receptors. Thus, even though serum T3 levels will fluctuate the effect on the cells is mitigated.
Your Endo should be guiding you and explaining everything so you know exactly what you do and what you can/can't do.
You sound unsure which is not good
I am not unsure but you have to understand that here most drs will not even talk about Natural hormones like Armour and most won't deal with T3 either because they don't believe in it. My new endo is the same with not believing in them but this dr will at least prescribe them if you really want to try it. I pushed the issue.
I was on Levothyroxine and kept telling my doc I needed T3. I too react weird to drugs. Finally found a new doc who did tests and did find I needed T3. So, she added Generic Cytomel. I was taking a 2-3 hour nap daily. In the evening my heart would pound weirdly. Someone on here told me I don't appear to be able to convert T4 to T3 properly, and that I needed Selenium. I added that. Still not better. Retested 3 months later for doc, and she told me to take 2nd Cytomel around 2pm. About 3pm I feel like I could go to sleep. Some days I have to nap, some days I can push through it. I gained 20 lbs in a month. Read a lot and found out I needed much more Selenium than I was taking. Once I started taking more Selenium, I am feeling better. I do get a rush an hour after each Generic Cytomel, but I am able to push through it. Weight gain has stopped. But now have those extra pounds. If you have Celiac or gluten intolerance, you have to take the generic, as brand has gluten! I did verify this!!! But, many say they feel much better on brand.
T3 with drs can be difficult sell. I have taken 200 selenium for months and some selenium is also in my multi. I started taking a piece of the cytomel tablet to start in the morning but once i adjusted i added the afternoon or i would crash. I don't have celiac or gluten intolerance that i know of. I take generic cytomel. I would think the generic has the gluten if any are you sue you didn't mix them up? Generics have fillers. I had to go off the levo (t4) and onto synthroif because i could not do levo because of side effects. I was told it is the fillers. That is why i was hoping they will switch my T3 to brand next time as it was suppose to be in the first place but pharmacy messed up.
Every time I make a change with T3 I get palps.. But it settles within a week. Seems the nature of the drug perhaps
Same here weeecone. Can I ask why some t3 users go back to ndt after becoming optimal on t3 only. Is there a reason for this?
Debbstar i won't be doing that myself. I used to be a vegetarian and currently do not eat red meat or pig so i won't do that stuff.
Please could you advise me by PM where I can source good quality T3, I am in the UK and will be funding myself under Endo supervision.
Thanks
I am in the US and am prescribed cytomel.
HASHISmom34 I'm totally with u on the med sensitivity! I just started cytomel... Dr said take 25 mcg pill in morning on empty stomachs!!! Thank God I am studied up on t3 and knew I would of been in ER if I did that.. I started the cytomel 6 days ago.. I started on 1 mcg 2x a day I'm now on 2 mcg 2 x a day and adjusting to it... I to need to avoid any bad side effects .. My system has been slowed down for so long that it takes time to adjust and get everything working do I'm not rushing this... I really want this to work.. I'm considering adding ndt at some point
Quiltgirl thanks for this. I know what you mean about the ER. I know it sound super funny to some me breaking up a 5 mcg tablet, but i am on synthroid too and it took me some time to adjust to that after being sick for so long. I am doing the same as you and just listening to my body.
I have tolerated T3 T4 combo amazingly well, surprisingly for me as I have many allergies/intolerances/reactions and have lost 10lbs in a short space of time. I take meds 6am and 4pm. I wish everybody coped like me. My endo wants me on 3 doses of T3 and no T4 in 4 months time. I actually have no fluid retention under my eyes since being on T3 which thrills me, reducing my T4 when I was symptomatic gave me puffy eyes within 10 days and I was not a happy bunny. I have been told by different endo's that T3 benefits are negligible and research does not hold up any benefits, I totally disagree as I am no longer chronically constipated, hair shedding has reduced and rosacea has disappeared.
Oh hair shedding reduction has caught my attention lol, that was your magic phrase. Yes face puffiness i think has gotten better since T3 introduction but still losing a lot of hair! Any dr who doesn't believe in T3 is a moron.
Hidden why does endo want u on just t3? That's wonderful to not have those symptoms anymore. I've suffered from flares of rosacea for 23 years.. Last October was the worst flare ever it was horrendous.. I've had bad constipation for 4 years and I take mag chloride it's the only thing that works.. I'm hoping I have same resolution of symptoms as you have had.
Quiltgirl, my fingers are crossed for you. He said my blood results show my TSH has been suppressed for years but this was never picked up and queried by my GP's, he has asked them to forward my thyroid history (which goes back 25 years). The suppression confuses me as I was so symptomatic and didn't convert T4 enough so he thinks removing T4 and upping T3 to 3 times a day is the best bet to stabilise my medication and prevent heart and bone issues of overmedication. Confusing I know but may have better answers next appointment.
Well my gp put me on t3 only because my antibodies were elevated.. I honestly was shocked. I was expecting t4 too. Well I'm adjusting its only been 8 days. I'm going slow! Really acting this to work. I've been taking 2 x a day so far
You will need a little longer for full effect Quiltgirl, I'm rooting for you. When I was prescribed beta blockers for my migraines it took a while to adjust to increased doses, along with thyroid med changes, but I'm glad I stuck with it.
Misslillykisses man I'm dragging and feeling so tired just like before I started t3. Temps and HR seem to be good not high at all... Today is day 10 . I did not have a good day yesterday either just so exhausted could hardly keep eyes open or sit up. I'm on about 3 mcg. 2x a day.. As long as temp and heart rate are ok do I just hold at this for a while? My dizziness vertigo and balance are flared as well... Trying to stay calm. When the dizzy stuff starts with the fatigue it sparks the anxiety.
Holding on, but welcome any advice..
Ty
My dizziness has stabilised now. Wouldn't harm to have GP appointment as 10 days in and feeling under the weather, just to rule out any viruses. Good luck.
when I took it I used to divide it as much as poss thu the day, then noticed I would start yawning when I was low so took it then and not if I didn't - which seemed to work.
I have a copy of living with t3 if you want it?
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