Thyroid meds taken at night versus the day and the cost-benefits of both

[FultonA]

Hi, I’ve tried multiple times switching my T4+T3 from day to night and it always seems that when I take it at night, though I sleep well, I’m much more tired and have less energy the next day and feel different cognitively. Anyone else experiencing that?

[Lalatoot]

Why not split your doses? I take half my levo and lio in the morning and half at night.

[FultonA in reply to Lalatoot]

I take tirosint, which is in a gel capsule so it’s not possible to split it up. I can however take the t3 at morning and the tirosint at night.

[HMBradley53 in reply to FultonA]

Take your T3 half dose morning with tyrosine half dose T3 evening

[Suzi_ in reply to Lalatoot]

I thought u were supposed to take your Levo, synthroid on empty stomach - first thing in the morning

[Lalatoot in reply to Suzi_]

You can take it any time as long as it is an hour before eating or 2 hours after eating. I have always split my levo dose morning and night. I did at one time split it into 3 doses morning afternoon and night making sure it was on an empty stomach as per the first sentence and 2 hours away from vitamins and 4 hours away from vitamins D.

[Suzi_ in reply to Lalatoot]

Thanks

The instructions I received from my pharmacy & dr is to

Take Levo on empty stomach

[SlowDragon Administrator]

How much levothyroxine are you currently taking How much T3

Do you split T3 into 2 or 3 doses through the day

Always get same brand levothyroxine and T3?

Got any recent results?

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

If/when also on T3, make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

What vitamin supplements are you currently taking

When were vitamin levels last tested

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Also vitamin D available as separate test via MMH

Or alternative Vitamin D NHS postal kit

vitamindtest.org.uk

[Suzi_ in reply to SlowDragon]

I posted my blood test results today to seaside suzy, hopefully I posted at the right forum

[SlowDragon Administrator in reply to Suzi_]

Can’t see any new reply by you with results

Suggest you write new post of your own

[Suzi_ in reply to SlowDragon]

Here are my latest thyroid lab results on February 4,21 USA, fasting blood test-

T3 free 2.9 ( range 2.0-4.4)

T3 total 119 ( range 80-200)

Tsh 0.201 ( range 0.270- 4.200)

T4 free 1.19 ( range 0.93-1.70)

Vitamin D 40 ( range 21-100)

Ferritin 35 ( range 10-291)

Iron 107 ( range 37-145)

I take 50 mcg levo, T 4 thyroxine and 5 mcg cytomel, Liothyronine T3 both first thing in the morning on empty stomch.

Since I have Alopecia aretera, lot of hair loss, trying to raise my ferritin level. Dr thinks taking vitron c will help with raising my ferritin levels.

I have been unable to find lambs lever here in USA.

Cholesterols level little high too.

I take one tablet of calcium, magnesium and zinc with vitamin D3 daily, also one Brazil nut daily.

What vitamin would help me?

My endo says results are fine, won’t increase my dose. Low tsh ok.

Thanks

[SlowDragon Administrator in reply to Suzi_]

Ft4 is only 38% through range Ft3 only 34% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Most people when adequately treated will have Ft4 and Ft3 roughly 60% minimum through range

Just 5mcg T3 is doing almost nothing other than lowerTSH

Suggest you increase levothyroxine by 25mcg daily so that you are taking 75mcg per day and retest in 6-8 weeks

Then likely to need to increase T3 by 5mcg

Split dose - taking 2nd dose approx 10-12 hours after first dose

Retest 6-8 weeks later

Ferritin is obviously too low

Look at increasing iron rich foods in diet

You need to test B12 and folate

[Suzi_ in reply to SlowDragon]

I am getting a error message in the percent link and another language.

I already asked my endo to increase my dose, he won’t, even though my hairloss is due to low ferritin.

I am happy that I have lost some weight and now back to 110 lbs, where I like to be!

What’s the best way to increase ferritin level if u can’t find liver.

I will ask my endo again. Thanks

[SlowDragon Administrator in reply to Suzi_]

Top row You put the Ft4 ranges in boxes on right ....bottom of range in middle box. Top of range in box on far right. Result in box on left

Next row

Ft3 result, followed by ranges

Push the button.....results as %

[Suzi_ in reply to SlowDragon]

Thanks

[helvella Administrator Thyroid UK]

I have collected a few links discussing time of taking doses - which I have previously posted. Just possibly of some interest?

Some papers which discuss taking levothyroxine at different times - such as bed-time.

Levothyroxine Replacement and Ramadan Fasting

pubmed.ncbi.nlm.nih.gov/237...

Effect of L-Thyroxine Administration Before Breakfast vs at Bedtime on Hypothyroidism: A Meta-Analysis

pubmed.ncbi.nlm.nih.gov/320...

Morning vs. Bedtime Levothyroxine Administration: What Is the Ideal Choice for Children?

pubmed.ncbi.nlm.nih.gov/303...

A Crossover Study Evaluating Effect of Timing of Levothyroxine on Thyroid Hormone Status in Patients of Hypothyroidism

pubmed.ncbi.nlm.nih.gov/313...

Effect of Timing of Levothyroxine Administration on the Treatment of Hypothyroidism: A Three-Period Crossover Randomized Study

pubmed.ncbi.nlm.nih.gov/300...

Alternative Schedules of Levothyroxine Administration

pubmed.ncbi.nlm.nih.gov/256...

Thyroid Diseases and Ramadan

pubmed.ncbi.nlm.nih.gov/228...

Pharmacotherapy: Hypothyroidism-Should Levothyroxine Be Taken at Bedtime?

pubmed.ncbi.nlm.nih.gov/213...

Effects of Evening vs Morning Levothyroxine Intake: A Randomized Double-Blind Crossover Trial

pubmed.ncbi.nlm.nih.gov/211...

Timing of Levothyroxine Administration Affects Serum Thyrotropin Concentration

pubmed.ncbi.nlm.nih.gov/195...

Effects of Evening vs Morning Thyroxine Ingestion on Serum Thyroid Hormone Profiles in Hypothyroid Patients

pubmed.ncbi.nlm.nih.gov/172...

[FultonA in reply to helvella]

Thank you for this, this is helpful in understanding that by taking the medication at night the amount of TSH secreted is the same or better than if there was a routine of taking it during the day.

However, the TSH measuring tool unfortunately does not always correlate with the symptoms experienced. Like for instance it doesn’t tell me why I’m all wired up after taking my thyroid meds in the morning and then why I am tired the next day when I don’t take them in the morning. I’m guessing, by experience, that there must be some immediate impact of the meds on us when we take them. Therefore if we take them at night, we sleep through this immediate impact and then the next morning we experience fatigue, depression, and other hypothyroid symptoms throughout the day

[helvella Administrator Thyroid UK in reply to FultonA]

I have always taken mine at bed-time - so do not have any other experiences to contrast!

[jimh111 in reply to FultonA]

TSH is higher at night because it has reduced bioactivity, so ignore the overnight peak in TSH from a clinical viewpoint.

[Lalatoot]

we sleep through this immediate impact - If you look at a the rhythm of FT3 , FT3 peaks at 4 am. This makes sense as even when we are asleep the body and brain are working - the gut is processing, the brain is tidying itself up and we are dreaming. Our metabolism and bodily functions do not stop overnight.

[FultonA in reply to Lalatoot]

very interesting, thanks

[Batty1]

I stopped taking my meds before bed it started to make me feel wired for some reason.

[FultonA in reply to Batty1]

Me too!

[Carna]

I take my Levo in the morning with half T3 dose and final T3 at 3pm. If I take it later in the evening I am up all night just about. I already sleep badly so I am trying anything to reduce that and taking thyroid medication at night does not suit me but I guess we are all different. I am also trying to take it sublingually and I think it may be making a difference but early days. One advantage is you don't have to avoid food or other medication that you swallow.

[Stourie in reply to Carna]

Hi I always take my meds sublingually. Have done for years. Jo. Xx

[Kimkat]

I take my Levo in the middle of the night because it’s easier for me with other meds and food. However I’m tired all the time snd I don’t think it changed when I started taking my Levo at 3 in the morning 🤔 I’m just tired all day every day.

[FultonA in reply to Kimkat]

Kimkat, such a great idea to take it at 3AM! I have adopted this and it helps allot; now I can drink that cup of coffee first thing in the morning without it interacting with my meds! That’s a big deal! 😄