T3 gave me afternoon fatigue. Has anybody taken T3 or Liothyronine as a starting dose in the afternoon?

So I started taking 5mcg of T3 with 75mcg of T4 first thing in the morning around 8am. I didn't feel any different however around 4-5pm I started to feel incredibly tired. I also couldn't sleep that night but I carried on for a few days. I managed to make up the insomnia the following night but couldn't handle the afternoon fatigue. I emailed my endo and he suggested taking it in the afternoon. I would have thought if I took it around 1-2pm then any fatigue would materialise around 9pm which is when I need to sleep.

Has anybody got any experience in this area? Has anybody experienced feeling tired and very sleepy after introducing T3? Thanks.

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34 Replies

  • Serendipitious,

    It's worth trying your endo's suggestion because if you do feel fatigued it will coincide with your bedtime and won't be a problem. Alternatively, you could take half your dose in the morning and a second dose an hour or two before the 4-5pm slump.

  • Thank you for responding Clutter.

    Slightly off topic, my endo has also asked me to try T3 but initially he said I want you to take 200mcg of Selenium daily and after 6 weeks test TSH, Free T4 and Free T3. I think he was hoping that 6 weeks of Selenium might improve everything. It will be six weeks in two weeks time. So I wondered if I start to take taking T3 and then have the tests in two weeks time won't that interfere with the test result? Will say a week or two of T3 show up in the result? Or should I wait it out and start T3 after the blood test? Also, I understand I should take T4 24 hours before the blood test but how about T3? Sorry if this is confusing.

    Letter from endo:

    "From the biochemical point of view, our next agenda item was to address the low Free T3 concentration on the last blood test. This can be addressed by the addition of selenium 200 μg daily which facilitates the conversion of T4 to T3. I recommend this as the first treatment plan."


  • Serendipitious,

    If your endo wants you to test thyroid levels 6 weeks after supplementing selenium only you should wait until you've had the blood test before introducing T3.

  • Yes I thought that would be best. I'm just finding it very hard waiting as I feel like I'm getting weaker, physically and mentally day by day. I'll wait another week and see how it goes. Thanks.

  • When I first started taking T3 only I couldn't tolerate it very well first thing in the morning so I took it early afternoon.

    As I slowly increased my dose I would always add the extra to my early afternoon dose. Once I'd adapted to that I'd move a smidgen of my dose to the early evening or bedtime. Eventually I started moving it to the morning. It was an awful palaver, but it was the only way I could tolerate T3.

    My personal feeling, based on some old adrenal saliva tests I'd done, is that my problem is high cortisol first thing in the morning. My cortisol was closer to being in the reference range later in the day and I tolerated T3 better at that time.

    I wouldn't be surprised if low cortisol introduced problems with T3 too.

    I suspect a problem you might be having is that 5mcg T3 is a tiny dose, your body uses it up very quickly, and you are reacting to the T3 running out - your body wants more - but I'm just guessing.

  • Yes like you say maybe it is the fact that it's a small dose and I need to use a method similar to what you've described to get used to it. That's very reassuring I really appreciate your response because I was extremely upset today about how my health has been especially bad in the last year or so.

    My GP lowered my Levo from 100mcg to 75mcg last April because my TSH was getting suppressed. I feel so stupid for not making the connection about why I've been getting more and more sick. First the 5 weeks of vertigo, then continuous fatigue and brain fog plus the insomnia. I was forced to leave one job only to lose the next one because I couldn't concentrate. In the summer my legs swelled up (despite wearing linen trousers) and became very red and itchy because my skin can't tolerate much sunlight. I always go out covered in sunblock or linen clothing but didn't think I needed sunblock on covered legs. My gums have been bleeding for weeks and despite religiously brushing with an electric toothbrush and flossing and using an interdental brush the blood won't stop. Even the dentist is puzzled. He also reminded me of the bone loss in my teeth but that must have happened over years. I'm sure my recent issues are all down this reduction of meds. 😥

    When you say you couldn't tolerate it, what exactly happened? My cortisol was slightly above range throughout the day when tested in December 2016.

    humanbean thank you once again for writing. It's given me some hope.

  • When I say I couldn't tolerate it I mean that my heart was going nuts - I had high BP, fast heart rate, I was sweating profusely, I was also getting pain in my chest. I also had symptoms I associate with high cortisol - feeling jittery, anxious, and fearful.

    Bleeding gums... I read about bleeding gums recently, and Hallelujah, I found where I read it :

    "Bleeding occurs, because vitamin C is essential for collagen synthesis – a critical building block of supportive tissue throughout the body. Loss of collagen leads to break down of various structures in the body. For example, the walls of blood vessel walls which, start to break down and ‘crack.’

    As blood vessel walls crack, they leak, and bleed. This leads to the best known symptom of scurvy, which is bleeding gums. This was well recognised several hundred years ago, mainly in sailors who had a highly-restricted diet during long voyages. In scurvy there is also bleeding in many other blood vessels, but you can’t easily see it. The usual cause of death in severe scurvy is internal bleeding."

    Source : drmalcolmkendrick.org/2017/...

    I have bleeding gums too. After I read that I started taking vitamin C again and hey presto! No more bleeding gums. It's a harmless experiment as far as I know, so perhaps you could try increasing your vitamin C intake?

  • My bleeding gums stopped when I added K2! I remarked as after a scale and polish spitting into the bowl was clear of blood. Infact it was a wow factor. I then asked the hygienist how my mouth was looking. She was pleasantly surprised and only produced a little blood when she jabbed me with the probe!

  • That's interesting I take 3000iu of D3 each day but not Vitamin K2.

  • K2 puts the calcium in your bones and teeth. My calcium was over range till I started on K2. If it's left in the blood stream can form stones

  • The only reason I've never taken it is because people say you only need it if you take 5000iu or more a day of D3. I've never had calcium tested. Where do you have this checked?

  • Doctor did mine

  • I'll go through my recent blood results in case it was tested. Thanks.

  • You're welcome

  • I've been taking about 500mg of Vitamin C daily in the last few weeks. Maybe I need to up the dose. Thank you humanbean.

  • Hello Serendipitous

    Reading about your bleeding gums I wonder if your dentist is good? I was switched to a different dentist in the practice a couple of years ago and the new one has worked wonders. My bleeding gums that had been ignored because my teeth were good, were infection which caused bone loss - sounds like you. Dentist treated me with a 'chip' inserted into a pocket in a receding gum and now the infection has cleared, the gum has closed in again and I am much, much better.

    Wondering if perhaps the same might work for you?

  • Hi thyr01d

    Thanks for you reply. Bone loss is exactly what I have too. My dentist said it was a few millimetres but nevertheless it's still bad. It isn't getting any worse though thankfully. Incidentally I will be visiting a new dentist on Sunday. However, I'm not sure what you mean by a chip? Is it a special filling?

  • Hello again Serendipitous

    The chip was a tiny thing containing something like Corsodyl (which dentist has advised me not to use because of thin enamel) which, after antibiotics, got the infection under control and has apparently improved the bone loss. I did also use magnesium oil on my jaw area and increase calcium in my diet and take Vitamin D3. The chip was not a filling but a little flat, square thing that I presume dissolved itself away over about 3 months since it was never removed.

    Do you also have osteopoenia? Sorry if you've already said whether you do or not, I can't remember.

    Hope that's of some help.

  • thyr01d

    I have been using Corsodyl mouth wash and I've been dunking my interdental brush in it to get the stuff into the affected area. It has helped somewhat but I think the infection is deep inside now as that's where the blood appears from. Are you saying Corsodyl is good for the gums and not for the teeth? I see what you mean by this chip. I'll ask my dentist about it on Sunday.

    I also take about 200mcg of Magnesium and 3000iu of D3 a day. I gave up dairy completely a few weeks ago as it was making me bloated but I do eat broccoli almost every day.

    I honestly don't know if I have Osteopoenia. I hope not! Thanks.

  • Hello again Serendipitous

    We do sound very similar and I'm sorry this is so long but I think it might help - in my case gum problem and bone loss seems to be linked with suppressed TSH, have you been suppressed too?

    Yes, Corsodyl is good for gums but depending upon the state of your teeth may be bad for them. My enamel is very thin and in places all gone which makes my teeth vulnerable and also they stain easily. Corsodyl apparently stains teeth even with good enamel if used for more than two weeks, according to my lovely dentist, who says it should only be used short-term. The staining can be cleaned by the dentist but this is bad for the enamel.

    My dentist first gave me a course of a very strong antibiotic then inserted the chip and advised me on using interdental brushes. That's the combination that has worked for me.

    Now, like you, I'm on T3 and having to sleep in the afternoon but I'm expecting this to improve as the dose is increased. My TSH is no longer suppressed and my teeth improving coincided with stopping Levothyroxine (and presumably TSH rising)

    I hope you are soon smiling!

  • thyr01d

    My TSH hasn't been suppressed. It has come down a bit in the last month though.

    Is this the sort of chip they used? us.periochip.com

    I'm going to try T3 again. How long have you been taking it and what dose? Are you taking Levo too?

    Thanks for the advice. I really appreciate it and I hope you feel better on T3 too.

  • I'm not sure if that's the same chip but it sounds very similar except that I was sure the chip contained antibiotic to control the infection. I trust my dentist absolutely and happily go along with whatever she suggests because she is excellent, remarkably kind and careful with costs.

    I can't really help at all with advice about T3 as I only started on it on 13th January but here are answers to your questions. The starting dose was 10 mcg daily for 28 days now I'm on 20 mcg (10 mcg am, 10 mcg pm) for two months when I'll be reviewed.

    No, I'm not taking Levo as well although that was suggested by the endo, I asked if I could take only T3 so that the Levo didn't confuse matters since it seemed to make me worse. I believe both together is better and the intention is for Levo to be re-introduced later.

    I think (but only think) my T3 was low because my dose of Levo was too high for too long. I also have low ferritin. I am hoping, as are the endos, that the low ferritin is a result of an absorption problem which is likely to correct as T3 levels are corrected. Then when ferritin is mid-range I am anticipating that my body will be able to convert Levo (T4) into T3 and I will be able to come off T3 and take the right dose of Levo on its own.

    This is all based on my very limited understanding of the thyroid and T3, T4 etc but I think it's right because it's just what the endos said at my appointment. Btw, the first endo I saw advised a higher dose of Levo, luckily my GP ignored that having seen me on the higher dose and instead she referred me to the current endos.

    There are others on here with far more knowledge and understanding, I do get things wrong, but I'm very glad if my experience is of any help to you.

    Still sleeping in the afternoons though!

  • I went to see another dentist today and mentioned the chip. She said the pocketing I had was very minor and should heal by itself and that there isn't any room to insert a chip either. I'm hoping it will get better by itself and by using salt water and gentle flossing.

    My endo recommended a starting dose of 10mcg of T3 but I wanted to be extra cautious and try 5mcg. So as recommended by humanbean, since yesterday I have now been taking it at midday as opposed to first thing with Levo and so far I've not had any major afternoon fatigue like last time. I didn't experience any fatigue or insomnia yesterday. I was a bit tired this afternoon but I think I'm alright now. I'm hoping if all goes well I'll up my dose to 10mcg after about 7-10 days.

    My Ferritin was 19 back in November 2016 and my endo said it was important to address this as its aids the conversion of T4 to T3. I ended up having an iron infusion and now it is at 150. From what I've heard it is important to address this first. I've noticed my basal temperature is higher and more stable too and I feel warmer too. Having said that at night I often feel cold to start with needing a hot water bottle and then I need a fan on my feet. I can't seem to control my body temperature. All the best!

  • That is good news Serendipitous about your teeth - my dentist advised me not to floss but to use the interdental brushes instead.

    Thanks for the info about the T3 and about ferritin, neither my GP nor endos are concerned and I don't know what I can do about that.

    It's nice to hear how you are going along and thanks for sharing your knowledge and experience.

    All the best

  • Regardless of what your Endo says I think the advice given here about Vitamin D, Folate, B12 and Ferritin levels is very relevant to thyroid health. Also Selenium is another important one. You can't go wrong with the advice here.

    This is a useful link about how hypothyroidism lowers stomach acid and affects iron absorption.


    I think fixing the thyroid will help with future iron absorption but it takes a long time to get optimal iron levels which are needed for T4 to T3 conversion.

    Likewise, it's good to hear about your experience and I'm glad you're getting on well with T3. Hopefully the need for you to sleep during the day will pass as times goes on. Thanks for your advice.

  • Hi Serendipitous

    I do understand the importance of ferritin (and others) but don't know what I can do. I've been on prescribed ferrous fumarate for 9 months, my level was 20 when tested a few weeks ago but has no doubt dropped since then, it drops very fast. I'm currently trying to get the GP practice to prescribe more but as I said the GP says 20 is fine (range 12 - 300) and endos want to address the T3 first, so I'm taking non-prescribed ferrous fumarate and hoping the endos are right in thinking the T3 will fix the absorption. They said that if not, they will address that next.

    All the best

  • You could wait and see what happens. Alternatively, you could post a new question on the forum and seek the advice of other members.

  • Thanks Serendipitous but I don't think anyone can give me more advice than they have already. I've learnt a lot in the years since discovering this site and there's someone else who has the same problem as I do with ferritin so we've asked questions.

    If you have a suggestion though perhaps you'll think of something we haven't thought of asking.


  • In that case I'm sure you're doing the right thing. I've only been using this website since October 2016 so I doubt I'll have any more knowledge and experience to offer. All the best!

  • :)

  • I also had terrible anxiety (shaking anxiety without provocation) before treatment. Don't get it anymore.

  • Found the thought of taking T3 at night an interesting one. My sleep is dreadful but a few days ago someone posted a chart of where the TSH, T3 and T4 were highest and I was surprised T3 highest in the night so may be if we are low that's when we should be taking it. May give that a try then I can take my B vits in the morning.

  • I take my t3 80mcg at bedtime and sleep well but am tired in the mornings. I have been thinking of taking 20 in the morning and just the 60 at bedtime to see if it makes a difference. Trial and error.

    Jo xx

  • When I first tried taking a dose of T3 at night I discovered that I did best with it if I took it just as I turned the light out and went to sleep. Taking it earlier than that would keep me awake.

    Now that I'm used to it I don't have to be quite so precise about the timing.

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