Some people can tolerate taking 10mcg T3 all in one go
Others find it better to take T3 as 2 x 5mcg waking and 12 hours later
Would recommend starting as split dose
Getting bloods retested 6-8 weeks later
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw). This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
If/when also on T3, make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test
There are different brands of T3 and just like Levothyroxine many people find they are not interchangeable
Always stick to same brand
20mcg tablets
Teva - upsets many
Mercury Pharma - not blister packed and frequently short use by dates
Morningside Healthcare - blister packed
5mcg
Sigma Pharma
Are your vitamin levels optimal
Did you get vitamin D, ferritin, folate and B12 test results and ranges
I started on just 2.5mcg 2 x per day .....gave a real "whoosh" for first few doses. I don't think I could have coped with larger dose initially......Then after 4-5 days this became less obvious, so then I increased dose to 2 x 5mcg. Held at this dose for 6 weeks and bloods retested. (Now on 20mcg per day - as 3 doses per day....1 x 10mcg at 7am and 5mcg at 3pm and 5mcg at 11pm)
Others find they can tolerate daily dose all in one go ......and it gives more subtle improvements
I've always taken my dose together whethere NDT, T4/T3 or T3 alone as I find it is easier to find a 'window' when stomach is empty.
It also means we don't have to concentrate when the next dose is due. I think it might be impossible to take it at the same time each day and also, stomach has to be empty.
The action of T3 is to saturate all of the T3 receptor cells and we have millions. Thereafter 'it' sends out 'waves' between one to three days.
I've just seen this post and how your endocrinologist, after deducing you've got a conversion problem, advised you to cut back 25 mcg on the LT4. That is not very much reduction if you're not converting, and they haven't measured rT3. From what I've seen of clinical studies, a reduction of 50 mcg would be appropriate, given the 10 mcg of T3 has a theoretical equivalency of 50 mcg of T4. This would suggest your trouble could be a reaction to too much T4 in the presence of that nice, powerful T3.
Theoretically, you could stop LT4 entirely for a day, given the way you feel. The surest way to see if you're taking too much of a particular hormone is to make a significant reduction for a day or two. If you feel significantly better by day two, then there's your answer. (Rule one of troubleshooting is to avoid making more than one change at a time.)
Everyone's different, so you have to feel it out. They're not testing rT3? This is how I determined there was a conversion problem. I could barely stagger around after the last dose increase to 75 mcg LT4. The endocrinologist was blasé about checking rT3 so I paid for it myself. When I showed him the report with the rT3 value above the reference range into the red zone, and he had seem me struggling, barely able to walk in my last visit with him, it was a teachable moment for him. He'd prescribed 75mcg LT4 and 5 mcg T3.
I had found a study of patients where the LT4 dose was reduced by 50 mcg and they were given 12.5 mcg T3 as a substitution.
I felt like a new person once I had eliminated that 50mcg and started taking 10 mcg T3. I do have a thyroid, though I'm unsure how much work it's doing anymore.
T3 at night does help sleep. I split my 22.5 mcg into three doses, 7am, 3 pm, 11pm, and it seems to enable me to function through the day and sleep at night. It is a good cure for insomnia, as hypothyroidism is a little-regarded major cause of insomnia.
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