Hi Community! US here. I see a lot of people that take Armour saying they split grains. Why the split? Those from the US that take Armour do you split mg's?
Armour, Why the Split?: Hi Community! US here. I... - Thyroid UK
Yes... in the US and have taken NDT for almost 20 years and have always split daily dosage. Reason?? Our thyroid gland doesn't dump our daily dose of thyroid all in one go and most of us just seem to function and feel better when we spread out dosage throughout the day. Let me add that it is a very, very individual thing and some do just fine with taking their meds all at one time. There isn't a 'right/wrong' to this. Whatever suits you is what you should do.
I also take my dosage sublingually (dissolve vs taking meds whole) so that I don't have to wait on food or drink. Some NDTs lend themselves to this practice .... some not so much. Again, an individual thing and preference. I firmly believe that whatever a person chooses to do (dosage/means etc), consistency is the key.
Hi phoenix23002! I'm learning as it's all new to me. Just had the surgery in February. I'm now on Armour 15mcg which I'm aware isn't going regulate my levels. However, I prefer to start off low and taper up. The pill I have is so tiny I can't imagine trying to split it, do they get bigger as the dosage increase?
I've never heard of the dissolving aspect either but I like that. I now take the Armour before I go to sleep and sometimes it's longer or shorter between the times I've eaten. Sometimes if it's too close to when I've eaten or have been snacking I'll take it when I inevitably wake up to go to the restroom 2/3am.
What dosage/kind do you take and do you only take the NDT? I've seen posts in which people mix with Syn/Levo or other thyroid meds.
I was on Armour for years, then Erfa (Armour changed formula and then became unavailable for a while), then WP and am now on NP by Acella due to WP being in short supply since RLC Labs (WP's mfg) changed their thyroid extract supplier. I like WP and hope to return to it depending on users' reaction to the 'new' WP.
I only take NDT since I don't seem to convert T 4 (Synthroid) to the T 3 that my body needs. The NDT supplies both T 4 and T 3.
Yes, the 15 mg that you are taking now is way too tiny for you to worry about splitting. Even when you step up to 30 mgs, that may also be too small a dose to fool with splitting. You are being put on a tiny beginning dosage. Most of us start off on at least a 30 mg pill and some even on a 1 grain (60 mgs) dose. Then you track body temp/heart rate and plan on increasing by 1/4 or 1/2 grain every two weeks or so. Most end up taking between 2 to 5 grains (120 to 300 mgs) to feel at their best. When you get to a place where you feel pretty good and are up to 2- 3 grains, time to wait 5 - 6 weeks then have lab work done again to see 'where you are at'.
I have been on a 2 grain dosage for years now and that seems to be where I do well and feel well. Going low and slow is fine but don't stay on too low a dose for too long. That is not good. The trick is to find that 'sweet spot'.
phoenix23002, Thanks. I know I'll trend up, it's just I had such a bad reaction starting with Levo 125mcg to 100mcg, then Syn 25mcg and 50mcg and while the Syn 25 was fine as soon as I was told to kick it to 50mcg the side effects kicked in and that isn't even a large dosage. So, now I'm so shell shocked I'm really like I'm good with slow. I'm just hoping, praying that as I increase that I don't have any side effects or at the very least side effects that had me balled up in bed not able to go to work.
I'm working on that sweet spot!!! Thank you for the information, it's great and thank you for responding.
You may have a reaction to some of the fillers. Medication has fillers to bulk up the tablet and to keep it stable. Fillers are present and often the fillers change in different brands. If you have no joy then I would consider a different brand and see if that helps.
Do get your B 12, D 3 and iron levels checked. Being low in those can adversely affect your ability to take NDT. It would also be good to take a 4 part saliva cortisol test to find out if your adrenals are functioning like they should. Our hormones do this delicate dance and are all intertwined with one another. It can be hard to pin down an exact cause as to why we can't increase NDT but it is worth the effort.
Some reading.... ??? stopthethyroidmadness.com/a...
At this point, I don't split. Only on 1.75 grain, but in process of increasing. I still have enough brain fog and feeling overwhelmed that I don't think that I could manage to have consistency with split dose. I may try doing so in the future when I am at a higher dose and feel more in control of myself.
Hi soupybp! Which NDT do you take? Do you think you need an increase? How long have you been on and do you experience any other symptoms? Do you take other meds with the NDT?
On 1.25 grain, TSH was suppressed but fT4 wasn't even half through range and fT3 was right at half through range. I increased to 1.5 on 4/30 - was actually feeling more brain fog and could not afford to be that way, so increased at two weeks to 1.75 on 5/14. Feeling some relief starting yesterday afternoon. I expect to need more increase that this before all is said and done.
Additional symptoms (at various levels at different doses) includes fatigue, insomnia, brittle nails, shedding hair, feeling resentful, tearful, feeling more self conscious, needing more affirmation, spacy and forgetful, cold extremities, heat intolerance, exercise intolerance, weight gain, puffy face, acne, high blood pressure, elevated lipids, beginnings of insulin resistance, and others.
I take the NDT alone in the morning. Later in the day I take lisinopril for the bp (but my bp is trending downward as NDT is increased...so I expect to be stopping that soon), vitamin D/K2 for deficiency, B complex w/addl B12 for low levels, iron for low levels, vitamin C, berberine with meals to help with insulin resistance, holy basil before bed to help with high morning cortisol, vitamin A, and magnesium.
The reason for splitting is primarily because T3 is a fast acting chemical, with a half life of around 6 hours.
Once its inside your body and being used to do things it can be a bit more complex than this, and the T3 in NDT may be slightly more slow release than pure T3 tablets.
The practical upshot is that if you take your whole dose in the morning you may end up finding that you feel at your best for the first half of the day, and have your worst symptoms in the afternoon and evening.
I started out taking all my NDT at once, and got away with it on lower doses. As I increased closer to my optimal dose I eventually found I was at my worst in the evening, so split my dose and had half in the afternoon. When I first did it I felt so much better it was the equivalent of a dose increase. I felt better in the morning as well as in the afternoon.
I now take my NDT in 3 separate doses. I've adjusted the balance between the 3 many times based on which part of the day I feel the best or worst in. The most recent change was when I realised I was feeling by far at my best after I'd eaten my main meal at 6pm, and really hanging about waiting for that food, which seemed to blow out all the cobwebs. In response I upped my morning dose and reduced the afternoon dose a bit, and it improved things again.
All you can do to adjust it is think carefully about how you're doing across the day, and if you can detect a difference, you may be better off with a split dose. Based on my experience I'd say the lower your dose is the less it probably matters, so if you're just starting out maybe don't worry for now. Once you've had a couple of dose adjustments and are feeling an improvement in symptoms you may find that part of the day is improved more than others. It's always more hassle to split a dose, as it means adding a 3 hour period when you can't eat (or have other medications) to your day, two hours before the tablet, one hour after.
Hi SilverAvocado! Love the name by the way. So, yes, I've been started on the lowest dose and I'm certain it will increase. What are your feelings you have from time to time as you mention detecting a difference across the day? Another responder, phoenix23002 "I also take my dosage sublingually (dissolve vs taking meds whole) so that I don't have to wait on food or drink." mentioned they would put their dose under their tongue so as not to have to wait or wait as long because of the direct absorption into the bloodstream. Perhaps that is something you could try.
My understanding is that the molecules in NDT are too large to cross into the bloodstream sublingually. It would be great if it could be done, as it's a huge nuisance not being able to eat for most of the day
One people do find by trial and error that they can get away with leaving a lesser gap or eating a bit. I do sometimes cheat by ten minutes or have a tiny bite of something.
Oops, forgot to answer. I'm still very ill, so initially I would find I was in bed in pain. It was happening in the evening, but earlier in the day I'd be more comfortable.
The recent feeling I mentioned where I was better after I'd eaten was more subtle. I just felt like I was on the top of my game after food, and a bit duller earlier in the day. I realised that I was looking forward to the after dinner feeling, at first without really consciously knowing why.
Recently I tried to reduce my evening dose because it made sense with the size tablets I can get and meant less cutting of pills. After a week or so I found I was often feeling a bit queasy and like maybe my blood sugar was low in the evenings.
It can be anything, really. It's just a matter of noticing how you feel at different times. Actually what I didn't mention before, it's also trial and error. Try something out, after a few weeks if you haven't felt any improvement you can drop back to where you were before, or juggle the quantities.
After my issues with Levo/Syn and actually while I was still on them I started taking them in the evening. So, now that I'm on NDT, I still take it before bed and I don't have to worry about eating because well, I'm asleep. However, I must admit on those evenings when I'm up a bit later and I want a snack, I snack so there's that.
With Levo/Synth taking at night is just as good and might be better than morning dosing. With T3 and NDT that contains T3 I'm not sure I've heard of it before.
If you take these at bedtime, the T3 will be peaking in your system while you're asleep. This may mean you sleep better, but it also means when you wake up in the morning you'll be in the dip with your T3 low, and by evening it will be worse. This is the reason that many people who split their T3 take the larger doses in the morning and smaller doses later in the day. I take a small amount of T3 with my NDT, and I've found it best to take it early in the day. I don't take any at all in my evening dise.
It might be an idea to try morning dosing to see how you feel, because you might find an improvement. If you take it at night because you need it to help you sleep, this is a reason you might benefit from splitting your dose.
Unfortunately with NDT just as much as synthetics we need to fast for 2 hours before, and 1 hour after, so if you're eating in that 2 hour period it may be disrupting absorption. This is one of those issues there is very little research on. We know it has an impact on synthetic T4, but the research hasn't been done on T3 and NDT. The general consensus is that it's best to leave the window and not eat, especially if you're not currently doing well.
Hi SilverAvocado! So far I'm doing well. I only know I'm low because of the numbers but not because I feel bad. It will be interesting to see what the next dose will be. I called the endo's office and waiting for a return call.
So, is NDT not a med that accumulates in your system? I'll have read/research more about it. I know that Levo/Syn accumulates because it takes several days for it to leave your system.
I'm not sure accumulates is the right word. It takes a while to start working, and is clunky in the sense that changing your dose will always take time to take effect. But my understanding is that's more about it taking the body a while to get used to it and make proper use of what it's got, as well as all the other chemicals and processes that get triggered by the hormone and then triggered other things later down the line.
Levothyroxine is slow acting, and slow to leave the body. The half life is around a week or so, this is why you don't need to split a dose or worry about taking exactly the same each day.
T3 is fast acting, and the half life is more like 6 hours. You can feel the effect of a tablet within an hour or so of taking it, and some people can feel when it wears off later in the day. Its important to take the same dose each day, because it won't average out in your body, it gets used up the day you take it. Although that is a simplification, and the effects of the tablet carry on after its used up and out of the body, because the things its triggered and allowed your body to make will still be there, etc, etc.
NDT contains both T4 (Levo) and T3. They are in a slightly different molecule form to the synthetic tablets, so it's possible they are a bit more slow to be absorbed. But overall they will have similar profiles to the synthetics. T3 will peak within a few hours of taking it, and then fall back, T4 staying in the body for weeks rather than hours.
If you feel great on what you're doing and don't have any symptoms, then it's fine to stick with it. Symptoms are more important than any of the other indicators, because others will always be an approximation.
Oh, okay. And as always, everyone will react differently. So, I was able to speak with the nurse and as I suspected my NDT has been increased from 15mg to 30. My fear is side effects because with the Levo/Syn I had horrible side effects, which is why I did some research, came across this site and learned about NDT and how it doesn't have the same issues, now I'm hoping that's the case. So, I'll start at 30 and see what happens. Thank you again for the information and responding.
30mg is still a very tiny dose. Its the equivalent of about 35mcg of Levothyroxine, which is lower than a starter dose.
I think with these things, all you can do is try. Even if you have a bad experience and have to reduce again, you'll still have learned new things.
Unfortunately getting better is a slow process and we have to have a lot of patience. There's lots trial and error, and sometimes we have to put up with feeling worse for a short time to feel much better later on.
Although if you feel very well, why have you been taking thyroid hormone replacement? Did you feel worse before you started this dose and 15mg has given a big improvement?
I've just gone back to look at your older post about side effects on Levo. I think I'd already known you've had a TT and forgotten.
Its extraordinary that you're going to work and feeling fine with such low free hormone and super high TSH. Do you feel completely fine with no hormone replacement at all, or feel a bit rubbish?
It may be that being mostly fine with these extremely low hormone levels is the biggest puzzle in your story! Everyone is different, though, and people do occasionally come through the forum who feel fine with blood tests that make them look very sick.
Hi SilverAvocado! So, I didn't start to feel bad until the Levo/Syn, even with the numbers looking as you started having to me to appear to very sick. The only physical issue I had was my not having a cycle for several months which actually started prior to my TT. But even now starting with the low dose of NDT, and when I'd stop the Levo/Syn at the time I was taking I felt and feel completely fine. The biggest issue I have now is the weight gain (8 pounds within a month), which I weighed myself yesterday and I'm holding steady so that's good. However, I obviously want to lose the increase in weight.
I do get sometimes having to push through the good and taking a higher dose and ticking down, however, for me it just wasn't working. I started higher with the Levo 125/100mcg, lower on the Syn 25/50mcg but still, the side effects were horrible. I literally had to call off work for a few days and I can't afford to do that, so for me at this point low and slow is what's hopefully going to win the race.
To answer why I'm taking the meds if I'm feeling fine, mostly due to the doctors stating that while my symptoms aren't showing now at some point they will rear their ugly head(s) and I admit I believe/agree with this. I did have some joint stiffness that I noticed went away when I did take the meds but at the time I didn't put the two together. Also, I don't want to keep putting on weight and add another health concern on to the thyroid issue. But, yeah I feel completely fine on the lower dose and starting off slowly. I started 30mg and will have bloodwork again in three weeks and go from there.
Since the process is slow anyway in trying to get the levels figured out, I'll opt for the low and slow since I'm feeling good now. I do notice that I'm sleepy so my bedtime routine has changed but that's a good thing because I could use the sleep!
Wow, its amazing you don't feel unwell off all hormone. I've also had a TT and when I go off my hormone I've always gained about 10-15lb in a week!! I've been lucky that even though I've been quite sick, I haven't consistently gained weight, only during those periods with no hormone at all, about 70lb in total.
I think weight gain can be a bit of a strange one, and it doesn't necessarily follow the pattern you'd expect. If you're lucky the 8lb gain might be your equilibrium point and you won't continue to increase. Some people lose it very quickly once they get one a good dose, and others don't lose it even once they feel very well.
Even though I'm still not very mobile, I've been losing weight for the last 18 months or so, only about 1lb a month, but I'm glad to be going in the right direction
Please keep me updated with how you get on!
I hope feeling well continues. And yes that weight gain is another type of beast so I'm glad you haven't had that issue to contend with on top of being sick. I was and am already to ask my doctor for a prescription my niece told me she was taking that helped her lose weight until I can get levels regulated just in case I start gaining again. Even if it won't help me lose, at the very least I'd hope it would keep my weight consistent until I can start losing.
I will report back. Thank you again for the exchange.
I take my 1.5 grains Armour NDT all at once in the morning (and I am in the US). That sees me through until 4:00pm when I begin to feel a bit tired, just not up to mowing the lawn type of energy. I completely crash about 9:00pm, but that's OK for my lifestyle. So, in answer to your question, some people split the dose so as not to droop mid afternoon. If I had to keep going full speed until 6:00pm, (i.e. finish work and drive home) then yes, I too would probably take an extra .5 grain around 4:00pm - note, that's not splitting a dose, that's just upping it a bit at a later time of day. When I work on the elections and we have to work form 6:00 am 'til 9:00pm I add .5 grain about 4:00pm because I became totally dysfunctional the first time I tried it without the extra pill. Thankfully I had a nice person who noticed this and made sure I got the easiest closing task! That was in 2016, so driving home was doubly hard.
Hi LAHs! Oh, wow! I'm learning a lot. One wouldn't think it would be so complex. Take the dose, figure out how much is needed, take that do once everything levels out and you're feeling fine but apparently not so. And yet still so much to learn as I'm just getting started.