T3 only: missed dose

[tcpace]

When on T3 only, how long does it take your body to let you know you've missed a dose and how does your body let you know?

[jimh111]

That's a tricky question. Thyroid hormone can have quick and long term effects. e.g. if I miss a T3 dose I might find I'm a bit tired a few hours after the missed dose but I wouldn't notice any effect on my bones because although T3 regulates bone formation it's something that happens over years. So, to directly answer your question you would notice any effect within a day but you might not notice anything because your body can react to short term changes.

If you've missed a dose and feel OK just ignore it and carry on as usual. If it makes you tired etc. maybe just take a fraction more the next time.

[tcpace in reply to jimh111]

Thanks Jim. I'm asking because my wife "crashes" or "hits the wall" if she misses her midday dose. It happens about 2-3 hours after the missed dose. One minute she's fine and the next she's extremely fatigued and can't think straight. If she then takes the missed dose, she doesn't recover until the following day and may feel out of sorts for a few days afterwards. Currently she's on 40mcg (20 on waking and 20 at about 1-2pm) but varies it according to the demands of the day. On a demanding day, she takes 60-70mcg. Just wondering if she needs to increase her daily T3 intake up to a level where a missed dose won't deplete her T3 to the point where she will crash.

[SlowDragon Administrator in reply to tcpace]

Sounds like she’s under medicated

When were her thyroid and vitamin levels last tested

For full Thyroid evaluation she needs TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Also EXTREMELY important to test vitamin D, folate, ferritin and B12

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 .

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

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/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[jimh111 in reply to tcpace]

Sounds like she is a little undermedicated but taking doses on waking and just after midday is not very well spaced. If she hasn't done so I would try taking half at bedtime and half on waking. I find the bedtime dose makes a big difference, it allows the brain to be active during sleep and helps with deep restorative sleep.

[shaws Administrator in reply to tcpace]

I take T3 in one daily dose, when I get up with one glass of water and it lasts for at least 24 hours. I follow the method laid down by one of Thyroiduk's Advisers and an expert in the use of T3. Unfortunately Dr Lowe died through an accident but I will give you a link.

He stated that one daily dose of T3 (at the dose that is optimum for the person) - i.e. too much would make you feel hypEr. He took his in the middle of the night so that nothing interfered with its uptake.

Myself, I take one daily dose when I get up and wait an hour before I eat. I used to take a larger dose but now it is lower.He stated that one dose of T3 saturated all of the millions of T3 receptor cells and it then sent out 'waves' throughout the day.

healthunlocked.com/thyroidu...

One dose saturates all of our T3 receptor cells, brain and heart contain the most and sends out 'waves' throughout the day..

[jimh111 in reply to shaws]

I wonder if Dr Lowe was a more unusual case, he needed 150 mcg L-T3 daily which is supra-physiological. Clearly he had some form of resistance to thyroid hormone (RTH) which I suspect might have been due to endocrine disruption. In this case his thyroid hormone receptors would need extra saturation in T3. When thyroid hormone binds to DNA it creates mRNA which tells various cells to make proteins to e.g. make the heart beat more, grow bones, keep warm etc. Some of these are long time effects and some very short term. On balance I would try and achieve a reasonably steady T3 level so that short term effects are smoothed out.

I had a similar problem but from my research and observing forum posts I think this is rare. Most patients on L-T3 need up to 50 or 60 mcg which is not quite supra-physiological, or at least not more than a total T3 + T4 hormone load a healthy person would have.

[tcpace in reply to jimh111]

Thanks. Smoothing out the daily dose sounds worth following up so she's going to try raising it, including taking part of it before going to bed. It does seem like she's slightly under-medicating overall given that missing a dose usually results in a "crash".

[jimh111 in reply to tcpace]

She can sort of monitor he sleep quality by making a note of how often she wakes up and how vivid / 'in focus' her dreams are. I find the bedtime dose sharpens up the reality of my dreams and I feel better the next day. You don't need to remember the dream, just a mental note of whether it felt sharp or fuzzy.

[jrbarnes in reply to jimh111]

Hi, how close to your bed time do you take your T3 dose and do you take any in the morning?

[jimh111 in reply to jrbarnes]

I take it immediately before bedtime. T3 levels peak about three hours after taking liothyronine so I get the peak dose around the time T3 would naturally peak.

I take my morning dose when I get up, a few minutes before breakfast.

Equal doses morning and bedtime but if the doses don't split 50/50 I find it's better to take the larger dose at bedtime.

[jrbarnes in reply to jimh111]

Thank you. I had been trying 8p and 11pm doses before bed.

[shaws Administrator in reply to jimh111]

Dr John Lowe was not only a doctor, but a Researcher and expert in Thyroid Hormone Resistance. I would think that few 'in any' experts in prescribing thyroid hormone replacements would have a clue about 'thyroid hormone resistance' and would probably prescribe an antide[ressamt instead of checking the Free T4 and Free T3s. I think they have lost track of these two important hormones.

I have no PEAKS on my dose at all. In fact I am completely unaware as my symptoms have resolved.

[shaws Administrator]

You will also find the following helpful:

dropbox.com/s/w7cjut689r1w1...

[tcpace in reply to shaws]

Thanks Shaws. I've taken the liberty of downloading it for future reference.

[radd]

tcspace,

It is not a good idea to change the amount of T3 medicated on a daily basis because it is so influential on other hormones, organs and mechanisms within the body.

It is more usual to experience a little tiredness and a not-quite-with-it than a total crash when meds are missed. Your wife's poor body probably doesn't know if it's coming or going if she is switching daily between 40mcg to 70mcg T3. I would say those symptoms of exhaustion would relate to adrenals struggling to keep up with such a sudden huge boost to her metabolism that is sometimes suddenly withdrawn.

She may find splitting the dose into three a day is more beneficial because this will reduce the rapidity of T3's onset and prolong the duration of it's action so giving a more even spread throughout the day. It is a pain having to space T3 around foods, coffee, iron sups, etc but when her long-term stamina were to improve then reducing back to twice a day may be better tolerated.

As others have said your wife may be under-medicated. To establish a dose that matches more to her daily needs but with good function, post any recent TFT's including the ranges (numbers in brackets) and members will comment.

[tcpace in reply to radd]

Thanks for giving your thoughts on this. Interestingly ramping her T3 intake up and down depending on the physical and/or mental demands of the day isn't a problem, If she didn't increase her dose on a more demanding day, she wouldn't be able to cope. Based on the informative responses received so far, we suspect she may be slightly undermedicated so she's going to try increasing her daily dose and also take part of it just before going to bed.