T3 timings. Advice please.

[Mickeydooley]

My endo recently increased my levo and T3 meds. (50 to 75mcg and 10 to 20mcg respectively). I’ve been feeling warmer, sleeping better and generally feeling better than before. I split my dose of T3 and take 10mcg with my levo between 4 and 6am and then take another 10mcg around 3pm. However lately I have been feeling jittery and shaky in the morning and wondered if the levo and t3 together might be too much? I don’t have the same issue when I take the t3 by itself in the afternoon. This morning I took 5mcg with my levo and haven’t had the same experience so I was wondering if I split the dose and took 5mcg four times a day would that be better? I’m going back to see the endo for a review on Tuesday and didn’t want to change the dose down before the next blood tests. Any advice would be appreciated.

[SeasideSusie Remembering]

Mickeydooley

It's rather silly of your endo to increase both Levo and T3 at the same time, we should only change one thing at a time. Also, it's best to increase T3 in 5mcg increments.

Increasing your Levo would raise your FT4 level and depending on how much natural T4:T3 conversion you have then your FT3 level could also rise. If your FT3 didn't rise enough then you could have added extra T3. Tweaking doses when on combination therapy is often a gradual thing, change one thing, see what happens, change again if necessary, see what happens.

It seems as though taking 5mcg instead of 10mcg T3 this morning suits you better, so you could take 5mcg 3 times daily and see how that goes. But if you don't want to reduce to 15mcg then take 5mcg 4 times daily. I think a lot of the time these doctors who prescribe T3 really haven't got much of a clue as to how to go about it. Or they set people up to fail the trial so they can withdraw the T3 and save the NHS money.

[Mickeydooley in reply to SeasideSusie]

Thanks for the reply. I’ve had a very stressful 3 months lately and my last results weren’t great. I think he was genuinely trying to help me. He actually wanted to put my Levo up to 100mcg but I told him I’d rather do it gradually. Now that the stress levels are reducing maybe I don’t need so much? I’ve been taking this dose now for 5 weeks and up until recently I was doing fine on it. I have also experienced weight loss but that may just be due to the stress and the fact that I tend to lose my appetite and struggle to eat. I thought I’d be better to keep up the 20mcg dose as it’s so close to my next review appointment and see how it goes from there. The only issue I have with the four times daily routine is keeping it away from food and drink although I’ve read that t3 isn’t as fussy about that as Levo so hopefully I’ll be ok.

[SlowDragon Administrator]

Perhaps you have too long a gap between afternoon dose and next morning

Personally I take my T3 as three split doses per day

10mcg at 7am, 5mcg at 3pm and 11pm

Levothyroxine 125mcg - I split this too ....weird...but seems beneficial....100mcg at 11pm and 25mcg at 7am

Are your vitamin levels optimal?

[Mickeydooley in reply to SlowDragon]

Will try three times a day dosing. Thanks. Last time my vitamins were tested they were all good except vit d which was within range but slightly low. I keep forgetting to take the vit d and k2 spray tbh but I’ll definitely try harder.

[SlowDragon Administrator in reply to Mickeydooley]

Many of us find T3 at bedtime improves sleep

Others try it and don't get along with it

[Mickeydooley in reply to SlowDragon]

I’ll give it a try. I suspect if I tell the endo how I’ve been he may reduce or stop my t3.

[Mickeydooley in reply to Mickeydooley]

Maybe a reduction would be best but we’ll see what the tests turn up. I have 3 days to try out the 3 times a day dosing and then I’ll decide what to tell him.

[SlowDragon Administrator in reply to Mickeydooley]

We would always say only increase one or the other...not both at once ..

But see if you can tolerate the double whammy

[humanbean in reply to Mickeydooley]

In your shoes I would have some little white lies handy, and if you end up taking less than you are prescribed then you can stockpile a tiny cushion of "spare" T3 just in case it gets deprescribed any time soon.

[Mickeydooley in reply to humanbean]

I’m having bloods drawn on Tuesday. The clinic only operates in the afternoon and I do take last dose of T4 24 hours prior and t3 12 hours prior to tests. I’m not sure what to do now. Do you think I could take 15mcg for the next few days and tell him I’m feeling well on the 20? Would it make a difference at this stage? Not sure how that would affect my results. I’m a bit confused.

[Mickeydooley in reply to SlowDragon]

I took my t3 in three doses yesterday and intend to do that until my tests but I have another question. I’m aware I should take levo 24 hours prior to test and t3 8-12 hours before but my test will be done around 2.30pm (clinic only operates in the afternoon). How much of the t3 should I take 8-12 hours before the test? Full 20mcg? 10mcgs? Or 5 mcgs?

[SlowDragon Administrator in reply to Mickeydooley]

Ideally test should be early morning.....

But if you have to do it then.

Yes Levothyroxine 24hours prior

T3 ....you normally take 10mcg between 4am and 6am . Suggest you do that as per normal. That gives 8-10 hour gap between last dose T3 and blood draw

But if worried he might reduce dose ...take only 5mcg

[Mickeydooley in reply to SlowDragon]

Thank you. X

[SilverAvocado]

If you're having a blood test soon I definitely wouldn't adjust the dose you're taking before then. Ideally you should stick on a stable dose for 6 weeks before a blood test. If you don't do that the results won't be reliable.

I think your symptoms suggest you may be a little overmedicated. But it could also be a bit of teething trouble with the new dose, or other explanations. The blood test will give you some good information to help make that decision. It may be that 15mcg of T3 is your ideal level.

In terms of dosing, I take mine in three doses. As you say, its a nuisance having to fast for three doses. But I get a lot of benefit from it, and I've adjusted the dosing schedule many times as I've adjusted the size of my dose and found that I have worse symptoms at different times of day.

[Mickeydooley in reply to SilverAvocado]

Thanks for your advice. I’ll continue to take the 20mcg until next bloods are taken but I’ll split into 3 times daily. I suspect that I am slightly over medicated. I’ve read that t3 isn’t as badly affected by food and drink as t4. I’m a bit of a grazer and meal times aren’t fixed at the minute (have to grab food when I can get it) due to my circumstances at the moment which makes it tricky. In your opinion will it make much difference?

[SilverAvocado in reply to Mickeydooley]

In terms of fasting for a dose I do two hours before my tablets and then one hour after. I keep to it fairly strictly, although I will sometimes have an mouthful of food or shave ten minutes off my fasting time to fit something in. At the beginning I was less strict and would sometimes just eat straight through on a special occasion, but I ended up feeling very sick on those days, so I stopped doing it.

I believe some people do eat with their T3, but it's quite a radical approach to dosing, so I wouldn't do that without a good understanding of why you're doing it. It reduces how much of the hormone gets into your blood stream, so you'd need a dose something like 30% larger, and to make sure you eat similar food each time.

Before I got onto three doses I was quite an irregular eater. I've found being on such a strict schedule has not been anything like as difficult as I thought in terms of the psychological side. I'm not able to snack at all except late in the evening, but I don't really miss it. I tend to have an hour or two window when I can have my lunch. It can be a pain if I'm seeing friends for a meal or doing anything outside of my usual timing. I generally need to know the night before what the timing of the day will be to make sure I have my morning dose and get on track in time.

[Mickeydooley in reply to SilverAvocado]

I generally try to stick to timings if I can but sometimes it means missing lunch or eating very late which isn’t great. My schedule is erratic atm as I’m on call for my elderly mother (my dad died a few weeks ago after an illness and being hospitalised) and quite often I have to grab food when I can. I’m sure things will settle down at some point but just now I’m doing my best. I just wondered how badly I would be affected if I didn’t leave an hour before food or 2 after. I appreciate your help. Thanks.

[SilverAvocado in reply to Mickeydooley]

I think all you can do is trial and error and see how much impact it has to eat closer to the tablets.