Should I split my T4 dose?

[ak_83]

I'm male with hypothyroidism and take a mixture of T4 and T3. Mostly I have taken this as a single dose 1 hour before breakfast. My ok dose is 150T4 and 15T3. A lot of symptoms go away. However, I think I'm experiencing some symptoms of overmedication, such as persistent joint pain and muscle injuries.

In an attempt to remove the single spike and possibly the symptoms associated with it, I'm trying to break up the T3 between morning and evening. At this stage it is 12T3 morning and 5T3 evening to try to mimic the decreasing T3 production (it totals 17 not 15, but my reason is that the evening dose will lose absorption). Any comment on this split?

My question is, is there any real point in splitting T4 as well as T3? The half life is 5-7 days rather than 24 hours for T3. But I have heard that when it is taken it still spikes in the blood. Is this accurate? I'd rather not overcomplicate things with T4 split, but if people have experienced significant benefit from it, then I should give it a go.

Just saw a few comments asking for blood test results. Here are my last three (have reformatted this again as when saved all spaces are stripped out) :

27/05/2021

FT4 - 19.0 (81% through the range)

TSH - 0.08

FT3 - 5.3

Dose - 150 T4 + 15 T3 - 5 weeks

14/07/2021

FT4 - 15.0 (29% through the range)

TSH - 0.16

FT3 - 5.6

Dose - 125 Т4 + 20 Т3 - 7 weeks

13/09/2021

FT4 - 16.9 (55% through the range)

TSH - 0.21

FT3 - 5.2

Dose - 140 T4 + 15 T3 - 9 weeks

Ranges:

FT4: 12.8 - 20.4

FT3: 4.0 - 6.8

TSH: 0.4 - 3.8

I'm actually thinking to reduce my T4 from 150 currently to 125 or 140 (see first and second rows) as 150 is over 80% of T4 through the range, which might also be contributing to some symptoms as I've heard too much T4 might also be bad.

The problem with the second line where I was on 125T4 and 20T3 is that I felt rubbish even though FT3 was better. I think it was because 20T3 is far too much for my body to take at once. I might try splitting T3 15 morning / 5+ evening and perhaps 140T4 to be over 50% through the range.

Interesting how just a small tweak in T4 creates a large FT4 difference...

[Hidden]

I have never split my T4 dose, but I know some people do. It´s all about trial and error.The reason it is recommended to take levo 24 hours before going to the lab is that FT4 levels will spike a few hours after taking it, which can cause false high FT4 levels and make doctors say you need to decrease your dose even if you are not overmedicated. Personally, I have never felt this spike in FT4 levels, but it does not mean you don´t as we are all different. But, as I said, the only way to know if you would benefit from splitting levo into two doses is to try it long enough; that is, for several weeks, and see if you notice a difference one way or the other.

I am not sure that taking thyroid meds in the evening will lower absorption, unless you take it with food or don´t leave enough time between supper and meds. I know many members here take both levo and T3 at night so hopefully you will get a lot of advice.

I don´t know about muscle injuries, but joint pain sounds like a hypo symptom to me.

Have you had your free T3 and free T4 tested on your current dose?

[ak_83 in reply to Hidden]

By lower absorption I meant food (lunch or dinner or snacks) will always interfere in the evening.

Yes, I test regularly. At the moment, getting the split right, blood tests won't be of much help I think.

[greygoose]

At this stage it is 12T3 morning and 5T3 evening to try to mimic the decreasing T3 production (it totals 17 not 15, but my reason is that the evening dose will lose absorption)

I don't think that does mimic T3 production. I think T3 production is highest at night, whilst you're sleeping and all that regeneration and reparation is going on.

But, why do you think absorption will be less in the evening? I've never heard that.

I'm also curious to know how you manage to split your pill into 12 mcg and 5 mcg. That sounds very clever! How big is your pill - 20 mcg or 25?

[Hidden in reply to greygoose]

I am reading a book right now by a doctor who claims that most hypo symptoms are caused by low FT3 levels during our sleep, which means the body cannot carry out necessary repair work. For that reason, he recommends taking T3 at bedtime. I think that adequate T3 levels are also necessary for cortisol production in the early morning hours?

[greygoose in reply to Hidden]

I think you're right about the early morning cortisol.

[ak_83 in reply to greygoose]

Lower absorption due to food interference. I take my 2nd T3 dose 15-30 minutes before dinner.

In New Zealand over the counter T3 is not available, you have to get a doctor to send the prescription to one of the compound pharmacies. They have a number of set dosages like 1, 2, 5, 10, 15, and 20 as well as being able to compound a custom pill.

My early morning dose is at 6 am, which should take care of that generation and cortisol production as much as practicable (not going to set an alarm for 3 or 4 am that's for sure).

[greygoose in reply to ak_83]

Lower absorption due to food interference. I take my 2nd T3 dose 15-30 minutes before dinner.

Well, that's easily remedied, isn't it. Either take your T3 sooner, or eat later. Or, take your T3 one hour after eating.

Have you read the book by Paul Robinson 'Recovering with T3'? That will tell you the best time to take T3.

[SlowDragon Administrator in reply to ak_83]

Why not take last T3 dose at bedtime….then you have good Ft3 at 3am

In a few weeks/months …..You could experiment with taking highest dose at bedtime….

[ak_83 in reply to SlowDragon]

Yes, perhaps I'll try that. It will automatically make it at least somewhat away from evening food.

[ak_83 in reply to SlowDragon]

I have tried 10T3 at 6pm, but felt overstimulated - hot and restless at bedtime. However, I'll keep it in my toolchest.

[SlowDragon Administrator in reply to ak_83]

Perhaps Try splitting 5mcg at 3pm and 5mcg at 11pm

See how that is

[NWA6]

How do you know it’s over medication? I doubt it with such an amount of meds. One of my main symptoms of hypothyroidism is joint and muscle pain. Many community members take t3 spilt in 3 doses per day and Levo with their evening dose. Personally I prefer to take only 2 doses of T3, morning and evening amd I take my Levo with that evening dose because I like to have coffee in the morning.

[ak_83 in reply to NWA6]

I've got records going back quite far, so yes my joint and muscle issues started on large T4 and T3 doses. Hence, must be over medication, rather than under.

[ak_83 in reply to NWA6]

What I find with higher doses of T3 in the evening is that I feel too hyper and hot. This makes me sleep badly and I just wake up exhausted.

[NWA6 in reply to ak_83]

From reading all your replies, I think I’d take 5mcg, split in 3 doses. Morning noon and night, if you feel you get a reaction. Keep Levo the same while you make this change and see how you feel. I’ve never had a reaction as you have mentioned, so can’t comment, only to agree with others that evening T3 often makes me sleep better. 150 Levo amd 15 T3 is about average, so it’s not really a high dose but then again we don’t know what your bloods are or what size of a man you are, so everything that members try to suggest is more guess work than usual.

[ak_83 in reply to NWA6]

Thanks, I'll keep this in mind.

[ak_83 in reply to NWA6]

Have posted the bloods. 150T4 I'm ~80% through the range, which is a bit high. I understand that I should keep my T4 <60%. With 125T4 I'm ~30% through the range. This is why I tried 140T4 as you can see, which is ~55% through the range.

[NWA6 in reply to ak_83]

Yes it’s a tricky balance, I personally like my FT4 to be around 60% through range too. 150mcg per day is 1050 per week, so a minor tweak could be just loosing 50mcg per week which will average out to 142mcg per day.

But really we are just all guessing, there’s no magic numbers out there to perfection.

I personally am not that sensitive to changes, but you may be and so that’s why I keep saying slow down and do minor adjustments, one at a time.

What about Vits and minerals? Are they all optimal? Could they be working for or against your thyroid function/intake?

[ak_83 in reply to NWA6]

I'm actually adding 15T4 compounded to my 50+50+25 available as tablets. That way it's actually 140T4 each day consistently.

Yes, I have recently done my B12, iron, vit D and all are optimal. So my working theory right now is too much T4 and too little T3, but the trick with T3 for me might be to split it to avoid overwhelming the system.

[Hidden]

Ps. What you say about decreasing t3 production makes me think you are confusing it with cortisol production which will be highest in the morning and drop throughout the day, being lowest at night (when the adrenal glands are healthy).

[greygoose in reply to Hidden]

Good thinking!

[ak_83 in reply to Hidden]

Yes, probably.

[radd]

ak_83,

Split dosing T3 is a great idea to try eliminating those last lagging symptoms, especially if you get feelings of 'hyper' as will help in preventing those peaks and prolong a smoother action. Many members have to split dose to accommodate compromised adrenals that can’t easily withstand one large daily metabolism boost.

We know the TSH circadian patterns means it is highest during very early hours of the morning & why when trying to get a diagnosis or med increase we have labs as early as possible. T3 roughly follows the TSH pattern lagging behind by between 1 -2 hours. Therefore, your proposed regime of a larger split in the morning & smaller later in the day is good for replicating the body’s natural actions, and if you read Paul Robinson’s book he actually wakes about 3am to take his first daily T3 dose. I take mine between 6-7am and then around 3-4pm but later if a late lunch were to dictate 😁.

Taking meds in the evening will not effect absorption unless you are worried about food interference, etc. The circadian pattern does not effect absorption but how thyroid hormones are utilised in the sense of all hormones being connected in a series of feed back loops. Even our waking cortisol (in another circadian rhythm) and night time neurotransmitters will be influenced by when we take our thyroid hormone meds. Some members even prefer taking their last T3 dose just before bed.

I have never found splitting T4 useful. Because of its longer half life peaks are only seen in the blood and not felt on a cellular level due to the many actions required for it to become 'live' (ie substantially T3 available for cell uptake). However, some members have complained of a 'bump' so split dose T4 for a smoother ride. It is only an individual's trial & error that tells what works best.

[ak_83 in reply to radd]

Thank you for confirming my approach. Does the 12/5 split make sense in terms of proportions?

I won't worry about T4 split. And just try to get the T3 split right.

Yes, by evening absorption being lower I meant that there will always be food in the stomach. It will never be as good as in the morning after 8+ hours of fasting over night. I have mine ~20-30 minutes before dinner.

[radd in reply to ak_83]

ak_83,

Yes, 12/5 is a good split. Before I switched to NDT I used to take 10/5 mcg T3 added to my Levo.

I notice you have added recent TFT’s and have made quite a few dose changes of both hormones. It would be best if you now remained on the present dose with the new T3 split-dose regime as only this will allow you to assess if split-dose changes have been successful. Remember each change can take several months for full benefits to be seen and split dosing T3 is yet another change in itself.

T4 becomes ‘too much’ usually when levels go over-range and/or (for numerous reasons) it is not being utilised properly. If tests were taken at the correct timings after last dose, your FT4 levels are fine. Also the the way the enzymes work in determining how thyroid hormones are activated (deiodinases) means having just a little T3 helps with further T4 conversion so T4 should be getting utilised well.

Some say thyroid meds should be absorbed within 20-30 minutes. I personally always leave at least 45 mins-1hour, especially if going for anything dairy or with lots of fibre, and be mindful of that second dose. Also, take thyroid meds away from other meds and supplements.

[ak_83 in reply to radd]

I test 24 hours after taking last T4 dose and 12 hours after the last T3 dose.

Thanks for the absorption times. I'll keep those in mind for my evening dose.

20 min before dinner would seem relatively easy to comply with long term. The simplest though, would be a bed time dose. But my bed time dose at 11 pm is only 7 hours away from my morning dose at 6 am. Is that a problem? I might have to ultimately try it.

If it works, I would not have to think about meds during the day. (That is how it works at the moment. I have a regular alarm at 6 am. I prepare the meds and a glass of water in the evening on my bedside table. At 6 am I automatically take it and go back to sleep for another hour - no problems at all going back to sleep.)

[samaja]

As a general point - it all depends a lot on your personal conversion ability which, from the fact that you are on 150T4, is probably not bad I presume and what is happening with Ft3 in your labs (where in range you are). 15 mcg T3 is a tiny, baby dose otherwise and would not make you overmedicated on its own. If you are on FB you could ask about splitting doses Paul Robinson himself in his Thyroid Patient's Manual group.

[ak_83 in reply to samaja]

Thank you. I'm not on FB. I'll see if I can source that book. Might be a bit hard in New Zealand.

I have posted several of my recent blood tests for reference.

[humanbean in reply to ak_83]

Paul Robinson's thyroid books and website can be found here :

paulrobinsonthyroid.com/

And you can buy the book on Amazon :

amazon.co.uk/thyroid-patien...

[ak_83 in reply to humanbean]

Hmm, there doesn't seem to be an electronic version, which boggles my mind. I haven't bought a physical book in over a decade! The closest place is Amazon Australia, which will probably take months to deliver it Wellington. I'll think about this...

[humanbean in reply to ak_83]

On the subject of there being no electronic version of Paul Robinson's books, I totally agree with how you feel about it! I haven't bought a physical book for years, unless there was some desperately important reason why I should and I had no other option.

I really don't want trees to be cut down to create paper books.

[samaja in reply to ak_83]

I believe that publishers were not exactly queing to for his book and he was doing most of it on his own. Not sure how easy is to publish an electronic version but I strongly suspect that money was always the issue for Paul projects.

I would drop him an email if you cannot connect on FB or Twitter and definitely read his blogs on his website.

[tattybogle]

i'm one of those that split a Levo dose of 112.5mcg into 2 (half at 6am & half about 11. p.m, but i never eat after about 7/8pm).... but i mainly do this to closer replicate the natural pattern (where fT4 is increased following the higher TSH very early morning) ,

....... and because i'm curious to see if the TSH is lowered more by one large dump than it is by smaller amounts taken more frequently.

It does seem that it might be , because my previous TSH for years was 0.05 ish, and since spitting Levo it's 1.9 without any other explanation for the change.. but i only have the one result so far .. so that's far from conclusive proof of anything.

...... but i'm only thinking of slightly higher TSH being a potential benefit to deiodianse conversion of T4 to T3 .. however if i was taking T3 as well i guess i might not be so interested in conversion, and i would imagine the effect of T3 on lowering TSH would outweigh the importance of any slight increase from splitting Levo dose.

Several years ago i used to split Levo and take half at about 2 pm.. and i did genuinely think it helped me function better after 4 pm through the evening, but not sure this wasn't just placebo .. and never had bloods done while splitting dose until now.

Now that i've got used to it, i do wake up at about 2 am if forget to take the bedtime dose... but couldn't say if this is because there is really anything different going on with my sleep, or just because my brain knows i forgot something and knowing that , it wakes me up .

[ak_83 in reply to tattybogle]

Interesting. I think based on most other replies, I will keep things simple and leave my T4 dose as a single one. But I will keep this in my toolchest to try if everything else fails.

[ak_83]

Just saw a few comments asking for blood test results. Here are my last three:

Date FT4 TSH FT3 Dose

------------------------------------------------------------------

27/05/2021 19.0 0.08 5.3 150 T4 + 15 T3 - 5 weeks

14/07/2021 15.0 0.16 5.6 125 Т4 + 20 Т3 - 7 weeks

13/09/2021 16.9 0.21 5.2 140 T4 + 15 T3 - 9 weeks

Ranges:

-----------

FT4: 12.8 - 20.4

FT3: 4.0 - 6.8

TSH: 0.4 - 3.8

I'm actually thinking to reduce my T4 from 150 currently to 125 (see first and second rows) as 150 is over 80% of T4 through the range, which might also be contributing to some symptoms as I've heard too much T4 might also be bad.

The problem with the second line where I was on 125T4 and 20T3 is that I felt rubbish even though FT3 was better. I think it was because 20T3 is far too much for my body to take at once.

[NWA6 in reply to ak_83]

I wonder if I understand what you’re doing? Are you changing both doses at once? Amd have you made all these changes in 4mths? So 6 changes in 4mths? Eckk I’d settle down for a minute so you feel what’s going on.

[ak_83 in reply to NWA6]

I do try each combo for 6-8+ weeks. With T3 change most symptoms stop changing after ~10 days for me. T4 is ~20 days. At times I have stopped short of 6 because I was just feeling awful. I still do try to last at least 4 weeks and get a test. I've found almost always it's either too low or too high FT3.

[NWA6 in reply to ak_83]

But you’ve changed both at the same time each time, I think that’s why I’m saying slow down. Change one thing at a time. So if you were going from 150 Levo + 15 T3 then I’d choose to go 125Levo + 15 T3. 6wks test + symptoms will help you decide what to do next, which may well be to increase to 20 T3. So that process alone might take 12wks. Hope that makes sense.

[JAmanda]

Ooh those numbers were hard to understand! But I think I got there and actually I’d say that you might benefit from a bit more T3. I had to get over 6 on the same scale before my hip pain finally improved. No migraines since either. Just a thought. You’re not 50% through the range in T3.

I see you think your pains are caused by the meds maybe … I’ve heard people say that about t4 but not T3. Maybe reduce t4 and increase T3.

I’m also faffing around with timings of T3 - I really can’t decide if one daily pattern is better than another.

[ak_83 in reply to JAmanda]

Yes, hence I'm thinking about 125T4 and split T3 maybe 15 morning / 5+ evening. Thanks for putting it in perspective 🙂

[ak_83 in reply to JAmanda]

Sorry about the formatting. It looked beautifully formatted when I was editing, but when saved all the spaces were stripped away!

[JAmanda in reply to ak_83]

Just my brain took an age to work it out!

[ak_83 in reply to JAmanda]

Have now re formatted in my original post...

[McPammy]

I split my T3 and T4 medications. T3 I take 8hrs apart as directed by my private Endocrinologist. I started having issues taking Levothyroxine T4 in one dose. So I started to split that dose also. I take liquid Levothyroxine so it’s much easier than splitting tablets. Your results look like your T3 maybe too high if you are leaving 8hrs at least before the blood draw. My experience of over medication is very similar to under medication. Maybe you need a small reduction in T3 also.

I believe I have to manage my energy output and dosage input. If I feel I’m going over medicated I just do more like walk further for a couple of days then i start to feel better again. Here in the U.K. autumn is with us and I’ve not been physically doing as much as I was in the summer months. Gradually over weeks I started to feel over medicated by waking far too early and agitation. I walked more and for longer then within a few days I felt better and slept normally. I feel it’s all a balancing act with energy output versus medication levels. I use to go the gym but still feel uncomfortable about going as covid infections are still too high here. I had a blood test done last week and I’m on the cusp of TSH being suppressed when normally it’s around 1.00. So that’s an indication I could be going over medicated also.

[ak_83 in reply to McPammy]

Interesting. You are the only one suggesting decreasing, rather than increasing T3.

Also interesting is the liquid form for T4. I have not heard of it in New Zealand. It would be convenient for splitting it for sure! I wish T3 was available in the form too. I have to spend a lot to get this stuff compounded as well as keep having to ask the doctor for prescriptions as they don't allow repeats on thyroid meds here in New Zealand.