I have responded to a poster on another thread about multi dosing T4 and it got me thinking about starting a specific thread about this issue because it seems not many people use T4 like this.
It does seem very common for T3 and NTH to be split up, so why not T4.
I have discovered T4 split up works better for me and am wondering has anyone else found this ?
I was taking my T4 at bedtime as this is another thing i have found makes a positive difference, but i was usually feeling a little more tired come early evening / late afternoon.
So i now take 50 T4 at bedtime and 50 waking up. I also take 25 T4 mid afternoon as i take 100/125 on alternate days.
So i am doing a split 3 times per day (2 times on alternate days). This seems to work well for me.
Hopefully this thread can become a place for good or bad feedback on this method and possibly some theories on why multi dosing could be a better bet for some patients. So all contributions are welcomed.
I am interested in why this may well be a better way to take thyroid meds and i will post up some ideas next.
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marsaday
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This quote is taken from Hashihouseman who responded to a thread i commented on recently. It is really good info and sheds light on why a more steady supply of T4 maybe the answer for some patients to feel even better.
T4 does have its own biological effects as part of the feedback mechanism particularIy on rate of T'3 conversion via its effect on D2, it is not inert until translated to T3 as some describe it and levels rise to a peak before equibilirating after Levothyroxine doses. The normal production of T4 in a healthy body may well be around the levels that l00mcg or so of Levothyroxine but it's never dumped into plasma all at once like a big single dose of Levthyroxine! we are told to take it all at once first thing on waking to maximise absorbtion and avoid inconsistencies in dose replacement. However, this comes at a cost of unphysiological T4 loading which for some people could adversely affect homeostatic responses such as intracellular Diodinase type 2 enzyme levels which are thought to generate more than half of all T3 !
One of the difficulties with multi-dosing oral T4 is avoiding interjection with foods, drinks (other than water), supplements and other medicines.
As far as I am concerned, we should be at the very least be investigating some sort of injected multi-micro-dosed T4. It might be wholly impractical for the real world, at least at present, but it seems entirely logical to see if people being dosed with T4 in a pattern as similar to that achieved in healthy patients, do better, or not.
Makes sense not to dump it all at once. I’ve been working a mixture of nights and days for most of my working life and have noticed that I can now (despite constant lethargy) cope with a 12 hr night shift better than pre thyroxine. Perhaps because I take it in the morning. I’m definitely going to try to split my dose and see what happens as night shifts are occasional...would prefer to have energy when most folk are awake.
Thought I'd comment here too 🙂 after our discussion
I've often not tolerated a higher dose or become ravenous after a high dose in morning and then flagged by afternoon
Generally I am high range t4 or even over medicated but T3 is just being dragged up slightly - possibly too much reverse T3 with high t4 dose.
I do feel that a more steadier dose would work better for me and strangely taking it at night Instesd of morning was better for me but convenience wise it didn't. I'm sure in past I ended up splitting dose here and there and it worked for me.
I mistakenly missed my morning dose yday and ended up taking half dose last night - so I guess my experiment has begun already 🙃
Will keep you posted how I do.
To add to your message regarding deoidinase activity and cortisol- a liver detox may be the first step to supporting these processes as well as considering splitting dose.
With regards to hunger and t4. Some people become more hungry after t4 and so they put on weight. The solution according to dr Blanchard (thyroid doc in the USA who has some great books out) is to take t4 with the evening meal.
He thinks the t4 is over stimulating the stomach receptors if I remember correctly and so people feel more hungry. This applies to some patients and not all mind you.
Does anyone have any updates on how this works for them? I had been splitting my Tirosint dose twice a day when I was taking that, simply because I found it extremely strong if taken all at once in the morning. But because of insurance reasons and digestion issues, I quit taking the Tirosint. I am just curious if anyone has found they have improved this way.
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