Thyroid UK
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Best time to take NDT when crashing mid afternoon?

Hi there! I am new here. I normally take 325mg of NDT daily split with 195mg 6:30am and 130mg 1pm. I crash terribly in the afternoon to where I must lay down for a while. Any dosing suggestions that may help? I typically never have an empty stomach except the first dosage of the day and eat 30 minutes after it. I am starving all the time. I usually have a little food at least every 2 hrs. I am starting Thyrovanz which I hear you can let dissolve in your mouth which absorbs much more quickly and then absorption is not such an issue. I did wonderfully for 4 years on Naturethroid and then crashed a year ago and have not been able to get rid of this mid-day severe chronic fatigue--that is my main problem. Have also tried WP Thyroid and NP thyroid and nothing has helped--always have been on same schedule with it etc.

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Can you try something very simple. It would be interesting to see what result you get.

Don't take any meds at 1pm, but leave it until 5pm and see how you feel in the afternoon.

There are a few things which could be going on and the only way to work it out is to try stuff out.

By not taking any meds until 5pm you will be restricting supply of T3 essentially. This may be the issue because the T3 is sucking up the cortisol, but afternoon time is a well know low time for cortisol. So if you don't take the thyroid meds you won't suck up as much cortisol and so you may feel ok.

It could be that you are wanting more thyroid meds and so by leaving a longer gap you may experience even more tiredness. If you do get this result the logical step is to take the thyroid med a little earlier so you don't get this low spot.

So you are testing out two scenarios by waiting until 5pm to take you thyroid meds and your reaction should give you the answer you need.

I am thinking it is more cortisol as opposed to a thyroid issue.

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Thank you for your suggestion. I can try that. I will say ever time I have ever tested coritsol--I think only 3 times-- I have low cortisol in the AM and High cortisol in the late afternoon/evening if that makes a difference. It has been a while since I tested it and that is when I had a 10 year span of a very high stress job and consumed high amounts of caffiene which is not the case in the past 3 years.

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I was dying by 3pm and could not wait any longer. I got my new Thyrovanz today and so I opened the 100mg capsule into my mouth and swear I felt better right away. What do you think about 3 doses, one at my usual 6:30am then 10:30am and then 2:30pm? I'm thinking of trying it since I am starting my downward spiral around noon but wait until 1pm since I eat at noon.

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Ok, so it looks like your body is running out of thyroid meds by lunchtime.

Do you have any blood test info which shows where your levels are ?

Certainly now worth taking some hormone earlier. 10.30am sounds fine.

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Are you able to see the labs I posted a little bit ago? It won't let me paste in the comments. I think there may be an iron issue.

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They look good. I am not used to your values as in another country, but the FT's are towards the top of the range. Iron seems ok. Ferritin stores are good.

what number of grains do you take ?

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I take 5 grains per day.

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How did it go today? Did you take some earlier than normal? Was the tiredness still there?

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So far I'm doing good! I normally take 3 grains 6:30 am and 2 grains 2pm, but today I took 1.5 grains 6:30am and 1.5 grains 10:30am and will take 1.5 grains again at 2:30pm. I think I already feel better than usual so far today splitting the am does and taking half of it at 10:30am. :) The severe fatigue usually hits around 1pm. We will see today how it goes with the new dosing. Almost noon now.

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Ok sounds good.

The T3 element of the NTH can often work better in some people if they spread it over the day. Some prefer all in one lump. It just takes a few bumps to find what works best for you.

With NTH this means splitting the dose and taking it in the smaller and more frequent quantities. With T4/T3 you can take the T4 in one go and then supply the T3 to suit.

I would also be interested in seeing what a small dose at bedtime does for you. Something like 1/2 grain. I find the T4 at bedtime to work so much better for me. It ties in with the circadian cycle which we all work to.

5 grains = 180mcg T4 and 45mcg T3

This is a big dose of thyroid meds, but if it works for you then great.

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I have been on 5 grains for 5 years of Naturethroid and it worked wonderfully up until a year ago when I just crashed severely and could never get back to feeling well again. I just switched to Thyrovanz yesterday so I have more room to adjust myself and I feel it is more effective already. I could add 1/4 grain before bed even taking the 1.5 grain 3x during the day (I bought 100 mg capsules and 25 mg capsules). I have always been terrified taking close to bed time may affect my sleep which isn't always very good. I wake up a lot, but fall back asleep pretty easily.

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Well your body may be struggling for thyroid and so using adrenaline while you sleep.

Many people experience better sleep if thyroid is taken at bedtime. some will be stimulated. We are all different so the best thing to do is experiment.

We make our thyroid hormones in the first part of the night and so taking the hormones at bedtime actually fits better with our circadian rhythm.

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Interesting, especially since I wake up very shaky in the morning - I do have essential tremor and have to take a beta blocker first thing when I wake up or cannot operate my mouse. It gets better as the day goes on though even without a beta blocker, so perhaps there is something to that my body using the adrenaline during the night and so adrenals are more taxed in the am. I will try adding a little to see how it goes. :)

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I don't think you will need the beta blockers long term if you fix the thyroid and adrenals.

I would do some reading about the sleep cycle. This blog is very good reading and is aimed at T3 only users, but the principals are the same if using T4 as well. Paul discovered if he takes T3 in the middle of the night he will produce much more cortisol for the next day.

recoveringwitht3.com

I myself have seen this as well in different saliva profiles i have had done over the years. But i have found my T4 works better if i take it when i go to bed. But i also wake up at 4am to take a small amount of T3.

The T4 only is so much better at bedtime and the T3 in the middle of the night gives even better results. It took me quite a long time to discover these benefits, but i have tried morning dosing on waking and the results just don't compare.

You use NTH so the results are possibly going to be a little different to someone using T4/T3, but it is worth experimenting. This is the same as tuning a car engine. The mechanic will turn one valve a bit and see what extra power he gets, then ups the oxygen a bit etc, etc. Tuning our bodies using thyroid hormones is no different. You won't get the answers over night, but eventually you will notice your tuning is suddenly working really well :)

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Thank you! :)

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I seem to get a surge of energy when I take the thyroid meds which lasts 3-4 hours. I worry that I will get that if I take it at bedtime and can't sleep... Do you take any during the day?

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YeagerCC,

Can you post recent TSH, FT4 and FT3 results and ranges? If you have any results and ranges for ferritin, vitamin D, B12 and folate post them too.

You may be reducing absorption of the dose you take if you eat and drink 30mins after taking NDT. Try leaving an hour between NDT and food/drink.

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I should have the TSH, FT4 and FT3 on Wednesday and will post. My ferritin, Vit D and B12 are usually very within range except my B12 was a little on the lower end last tested and so I have been supplementing that. I will say that it is 12:28pm here now and my eyes are already feeling very tired which is usually a hypo symptom for me. My last does of 195mg was 6:30am and I usually take the next one at 1pm, but I'm going to try to wait until later as marsaday suggested to see if it makes a difference with my afternoon fatigue. It may be that I need to take the 2nd dose earlier like around 11am. Not sure yet.

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Yeagercc,

Post the results and ranges in a new post as updates are often missed.

You will need to experiment with timing to find what is optimal.

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Thanks! Will do!

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Are you taking 5 grains of NDT per day. That's a lot have you posted your blood test results before?

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I posted mine from last week this morning if you can see them. I just posted thyroid and iron levels. The recommendation is to back off by maybe a quarter grain to 1/2 grain. the fatigue is debilitating midday.

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Yeagercc, there are two main options with dose juggling - either add a third dose or try moving your second dose later in the day. It sounds like you feel you really need it at the time you take your second dose, so try adding an additional one.

I take 3 doses a day, and definitely feel you on the hunger! I am hungry a lot of the time, but that's better than fatigue. Also, because I have to eat at specific times to allow my tablets, overall symptoms I get from being too hungry are reduced. I used to get reactive hypoglycemia, but it's less bad now.

When I've split into additional doses I've found I feel better all day - it feels the equivalent of a dose increase. When I first added an afternoon dose I found I felt much better in the morning as well!

I've also found that as I increase my dose, I need split doses more. For ages I managed on a single dose, but I think as I started to feel more well, it mattered more that there was an afternoon slump.

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Yes! Thank you for the input! I added a second morning dose splitting my normal 3 grains into two doses instead of one at 6:30am I did 6:30am and 10:30am this morning and already feel like it is better today. My terrible slump time comes around 1pm normally when I take my 2nd dose of 2 grains which I am going to take at 2:30 today since I added the 10:30am dose making it 1.5 grains every 4 hours for 3 doses. We shall see how I hold up today. :)

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I take my third dose shortly before bed. I tend to believe it helps me with sleep. Although recently I've started to push it earlier as I've had the problem that I start wanting to do fun things at the time I should be tucking into bed.

Anyway, if you're reluctant to split a third dose because you can't stand the dreaded 3 hour gap (2 hours before meds, 1 hour after), the least painful way to add an extra dose is around bedtime. Weirdly this might make you feel better in the afternoon. Of course it also might not, but maybe worth a try :p

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Thanks! I may just add a quarter grain before bed in addition to what I am taking during the day. I just started on the Thyrovanz and understand it is a little less than what is in the Naturethroid, so I think I should have room to do that and still not over medicate. I'm so paranoid about taking it around bedtime fearing it will interrupt sleep.

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Interrupting sleep is something you just have to experiment with. Some people find it stops them from sleeping, and for others it helps.

You need thyroid hormone and energy while you sleep just as you do when awake, to keep your heart, lungs, etc, etc all going. But it depends how your body handles things whether you benefit from a tablet :p

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We shall find out. :)

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I crash when I'm undermedicated, though from what you've written, the issue seems to be eating too soon after your THs.

After initilly being ignorant regarding the efficacy of leaving at least an hour before eating, & avoiding certain foods, & especially other meds, hormones, & supplements for longer. My first six months recovery was scuppered & slow due to taking HRT & vitamin D first thing with breakfast. Once I left a longer gap, ie, much longer than an hour, & took supplements with or after lunch & hormones (vit D & HRT) with a >6 hour gap, everything worked better. As I buy my own meds, it's as important cost wise as medicinally effective, to be careful not to further sabotage my finances & health.

I stick to restrictive eating times, which suits medication & supplements at either end of my eating window. I find it easier to do this providing I have enough protein & good fats during the 6-8 hours I eat, & usually just need water inbetween. Occasionally I eat at breakfast time, as long as I've left a sufficiently happy gap of over an hour after my TH intake.

You might find taking yours with a little apple cider vinegar or plain ascorbic acid powder in the water, to increase stomach acidity & absorption, will give your NDT a boost.

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Thank you!

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