Good news about to start T3 - any tips on timing?

[Hashi-hacker]

Hi, I saw a private endo in Edinburgh yesterday and she's starting me on 5mcg T3, and cutting my levo from 100mcg to 75mcg, as my most recent bloods show poor conversion (and I have the DIO2 gene mutation). She said to do the switch immediately, that is, drop from 100mcg to 75mcg and start the 5mcg on the same day. I forgot to ask about timing of taking the pills, so I'm assuming it's the levo and half T3 on waking on an empty stomach (7.15am) and then she said to take the second half of the T3 with my evening meal which for me is about 6pm ish. Does this sound about right?

On another note, she's writing to my GP to see if they will approve the T3 trial, otherwise I will have to use a private prescription and I can get that fulfilled through her at about £90 a month. Not sure what brand it is but apparently it's from the states. Obviously I am crossing everything that the GP will approve this, otherwise, does £90 a month sound about right?

Thanks!

[greygoose]

No, it doesn't sound right. You shouldn't take T3 with food. You should take it in exactly the same way as you would levo. Also, 5 mcg is such a tiny dose, splitting it seems a bit futile. Did she say anything about increase after two weeks?

[jimh111]

Liothyronine is rapidly absorbed but I would take it on an empty-ish stomach as greygoose says. We used to take it with meals to slow down absorption to give an even dose. I'm not sure this worked but it didn't seem to impair absorption. I've found the bedtime dose of L-T3 more effective, it gives deeper sleep and better brain function the next day. I would take the 5 mcg dose before bedtime and assuming you get an increase go on to take half at breakfast and half at bedtime. You won't get any benefit from 5 mcg, it's too little, equivalent to 15 mcg levothyroxine ncbi.nlm.nih.gov/pmc/articl... . You will need an increase to 10 mcg at least.

If you GP will not prescribe get the endo to write prescriptions for 20 mcg liothyronine. You can split these tablets quite easily and take half or quarter at a time, they don't have to be split perfectly, the small differences in dose will even out during the day. You can order 20 mcg tablets at a reasonable price from Germany thyroiduk.org.uk/tuk/treatm... .

[Hashi-hacker in reply to jimh111]

Thanks. I have to be honest I was so blown away that she was prescribing me the T3 that I may have missed something in the details, it might be that I'm going to get a prescription for 5mcg x 2 per day and it was my interpretation that I would have to split the 5mcg dose. I will of course get that clarified.

She said the follow up would be in 3 months.

(It's a 3 hour drive for me to get to see the endo so that doesn't also help with the concentration.)

[Murphysmum in reply to jimh111]

Just to say I slightly disagree with you!

I only take 10mcg per day (so 2x5mcg) and I saw a massive difference.

I think we’re all very different 😊

[jimh111 in reply to Murphysmum]

Interesting. I didn’t express myself very well, I meant to say 5 mcg will not be enough to represent a genuine trial. The patient must be trialled on incremental doses up to at least 20 mcg before saying it doesn’t work. I did once hear of a patient who needs just 5 mcg daily but I suspect this is unusual.

[MaisieGray]

There is no evidence/studies that I know of, that confirms food interferes with T3 in the same way that it does with T4, and in fact some evidence that it does not; and many followers of Paul Robinson's mono-T3 protocol don't separate food and T3, and have no problems. However, neither is there any evidence that it 'should' be taken with food as you've been advised. Over the past 11 years, I've generally taken my T3 with my Levo at night, but for a while recently I tried taking it during the day but without worrying about the Levo guidance of 1 hr before/2 hrs after separation, and experienced no change whatsoever.

Whether you need to reduce your Levo very much depends upon your existing hormone levels; it shouldn't be reduced simply because you are adding T3 in the absence of knowing how adequate/inadequate is the existing dose.

[Murphysmum]

I see the same private Endo and for 90 5mcg tablets it’s currently £126.50.

Obvs lasts about 6 weeks in 10 Mcg/day 😉

[Khan-123]

Please can someone forward me to this endo. Any details will be appreciated via pm

Thanks