Starting T3 medication

[Redporti]

At my last blood test my TSH was 2.11-(0.465-4.68), Free T4 15.0-(10.0-28.2) & Free T3 3.1-(4.3-8.1). My endocrinologist wants me to start on T3 medication. She told me not to take it before I go to bed as it will give me an energy boost & keep me awake all night. I already take Levothyroxine 50mcg at bed time. What is the best time to take it?

[EZM1]

I don’t take T3 but do take Levothyroxine. I’ve always been advised to take this first thing in the morning on an empty stomach and then not to eat for at least 30 minutes.

[SeasideSusie Remembering]

Redporti

She told me not to take it before I go to bed as it will give me an energy boost & keep me awake all night.

Everyone is different. Many members take their T3 at night and find it's better for them, others do better taking it in the daytime and maybe splitting the dose. Apparently our bodies make most T3 at night so it sounds quite sensible to take exogenous T3 at night, or at least try it.

I already take Levothyroxine 50mcg at bed time. What is the best time to take it?

There's no reason not to take it with your Levo at bedtime. If it doesn't suit, experiment by taking it at another time. I take Levo and T3 together but take mine in the early hours of the morning when I need the bathroom, often between 3am and 6am. I split my dose and take my second half around 4.30pm. Follow advice as for Levo, i.e. take on an empty stomach, one hour before or 2 hours after food, no other medication or supplements for 2 hours so that nothing affects its absorption.

[Redporti in reply to SeasideSusie]

All sounds sensible to me. I was just wondering why she said don’t take it at night when you take your levo as it will keep you awake.

[greygoose in reply to Redporti]

Because, like most doctors, she thinks T3 gives you some kind of high. Well, it might for some people, but not everyone. Never did that for me, wish it did. lol

[SlowDragon Administrator]

50mcg levothyroxine is only a starter dose of levothyroxine

Your Ft4 is only 27% through range

chorobytarczycy.eu/kalkulator

Wondering why your endocrinologist doesn’t increase levothyroxine FIRST?

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 is in top third of range and FT3 at least half way through range

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Have you had thyroid antibodies tested?

Ask GP to test vitamin levels

Vitamin levels need to be OPTIMAL before starting on T3

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

Is this a private endocrinologist?

Seems to be rushing you into T3 before trying levothyroxine

[Redporti in reply to SlowDragon]

She took more bloods yesterday so I have to wait for results. I need my TSH as low as possible as I had papillary cancer last July. If my TSH has gone lower but my Free T3 is still low then she wants to try T3 too. All of the above tests you mentioned she has done this time. My vitamin D is 120, folate is 25 & b12 is 1120 as I self inject as I had a terminal ilium resection. I just didn’t know why she thinks it would keep me awake if I take it at night with my Levothyroxine?

[SlowDragon Administrator in reply to Redporti]

We are all different

Personally I have to split the T3 into 3 doses ......taking small dose T3 before bed improves sleep for many of us

Many endocrinologists think T3 is like “speed” .....but in reality it’s often more calming

Just like Levothyroxine....different brands suit different people

Surely after total thyroidectomy you should have been started on full replacement dose of levothyroxine?

New NICE guidelines

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

BMJ article also clear on dose required

bmj.com/content/368/bmj.m41

How to get TSH as high as possible so that dose is increased

thyroidpatients.ca/2020/01/...

[Redporti in reply to SlowDragon]

I only had half of my thyroid removed but the bit left isn’t working properly due to Hashimoto’s. I guess if she gives it to me I will have to experiment with it to see how it makes me feel. Thanks.

[Lalatoot]

The circadian rhythm of T3 means it is at its highest level in the body at 4am. I take a dose of T3 at bedtime to try to replicate this natural pattern. Have no problems with sleep.

I would also add that your TSH is high for someone on levo and you might benefit from a dose increase. Don't alter levo and T3 at the same time.