Should you take T4 and T3 at the Same time of Day?

[LeiL]

I started taking 5 mcg of T3 on 1 Oct along with my previously prescribed 100 mcg of Synthroid. Just had new labs done on 1 Dec and while my TSH lowered from 1.0 to .19 and my T3 and T4 levels are also lower. My RT3 went higher. I’m also having stomach issues and pain in the right flank.

The GP who prescribed the T3 is suggesting that I increase my T3 to 10 mcg. I think that I’m not absorbing the medications. The T3 has helped significantly with my depression and fingernail lifting issues but cholesterol levels remain high.

Any recommendations?

[greygoose]

If the T3 is helping with your depression, then you must be absorbing it.

But, 5 mcg is only a tiny dose, which is why you still have the other symptoms of hypo. And, whilst it's enough to reduce your FT4 level - which is normal - it's not enough to raise your FT3. Your FT3 has probably dropped because your FT4 has dropped, so you're not getting as much from conversion, but the 5 mcg is not enough to compensate.

That all adds up to needing an increase in dose.

rT3 has nothing to do with anything. There are many, many reasons for high rT3, and only one of them has anything to do with thyroid. And that is when your FT4 is too high. From what you say, your FT4 is not high enough to cause over-range rT3. Although it might be helpful if you posted the actual numbers: results and ranges. rT3 is inert and doesn't cause symptoms.

[LeiL in reply to greygoose]

Thank you for your response. Here are my current lab results with reference range in quotes.

TSH .19 Reference Range (.40-4.50)T4 Free 1.4 (0.8-1.8)

T3, Free 2.8 (2.3-4.2)

T3 Reverse 23 (8-25)

Ferritin 96 (16-288)

[greygoose in reply to LeiL]

So those results are on 5 mcg T3? Your FT4 is still quite high - higher than I expected. So, could be responsible for the high rT3 - although the rT3 isn't that high, it's still in range. It's not a problem, anyway.

The FT3, on the other hand, is still pretty low, so you would probably do well to increase it by 5 mcg.

[greygoose in reply to greygoose]

Just realised that I didn't answer the question in the title. Should you take T4 and T3 at the same time of day? Well, you can, no reason why not. Depends if it suits you that way. And that's something you'd have to find out by trial and error.

However, if you take them both at the same time, you will need to make some adjustments the day before the blood test. There should be a 24 hour gap between your last dose of levo and the blood draw. But only an 8 to 12 hour gap for the T3.

[LeiL in reply to greygoose]

I have to admit that when I took the test, I’m pretty sure my last dose of T3 well exceeded 12 hours. More like 36 hrs.

[greygoose in reply to LeiL]

Oh good lord! That is a very, very false low, then. So, perhaps you don't need an increase in T3. I would suggest you get the blood test redone before trying an increase, and do it correctly next time.

[LeiL in reply to greygoose]

T3 decreased from 3.1 to 2.8 and T4 decreased from 1.6 to 1.4. I still don’t understand why both would decrease. I normally skip T4 a full 24 hrs before testing. Not sure if it had anything to do with it but I took an exercise class right before my blood draw appointment at 11 am. I usually have blood drawn about 8 am. The lab I use went to appointments only so early times are hard to get. The GP think I’m having conversion issues.

[greygoose in reply to LeiL]

FT4 level always reduces when you start taking T3. That's normal.

Your FT3 level reduced because you left such a long time between the last dose and the blood draw. But, because you left such a long time, you've got a false result there. If you'd just left 12 hours it would have been much higher.

Plus, having the blood draw around 11 am, means that your TSH is lower than it would normally be. So, all in all, those labs aren't worth much, and you can't compare them with the labs from before because they weren't done under the same circumstances.

I'm sure you do have conversion issues. That's why you were given T3.

[LeiL in reply to greygoose]

Also, any recommendation on how to minimize the stomach burning when I take my thyroids meds? I think they are hard on my kidneys but don’t have any other options.

[greygoose in reply to LeiL]

I'm afraid I don't know what you can do about stomach burning. Have you always had that? Do you think it's the T4 or the T3 causing that?

Why do you think the tablets are hard on your kidneys? I don't see the connection.

[Miss81 in reply to greygoose]

Hi I want to ask why we need to adjust taking the meds at a different time before doing blood tests? Wouldn’t that be disruptive to the system and how can it be done anyways? Example, I take my T4 40mcg and T3 8mcg at 10pm just before bedtime. Then at 5:30am i take my other dose of T3 10mcg. And then my other T3 dose of 2mcg at 1pm. So my total dose is T4 40mcg, T3 20mcg. Now, how do I adjust this if I was to take a blood test? Paul Robinson talks in his book that adjusting it by 30min makes a difference to the system and here we are in general saying it should be adjusted before a blood tests? That doesn’t make sense to me because then the blood test wouldn’t be correct and or also the system would be mandled with if we adjust things before blood tests..? Can someone explain this pls ? Also if we take the meds at particular time of the day for a reason changing this just for a blood test would give results for the day of the blood test not the actual real result which would be if we take the meds as usual and do a blood tests.

[greygoose in reply to Miss81]

Hi Miss81.

This thread is two months old, so very, very few people are going to be reading it now. If you want detailed explanations, I would suggest you copy and paste this question into a new post, so that everyone reading posts today sees it.

I know nothing about Paul Robinson's methods, but I can tell you that we always advise leaving a gap of 24 hours between your last dose of levo and the blood draw, and 8-12 hours for T3. This is to get an accurate reading of your normally circulating levels of hormone. If you leave longer, you will get a false low. If you leave less time, you will get a false high. Which can have disastrous effects where doctors are concerned.

[Miss81 in reply to greygoose]

Ok if that is a statistics. That would mean takin T4 at night then T4 in the morning then doing bloods the next day? Is this correct?

[greygoose in reply to Miss81]

No, I don't think that's correct. Why would you take T4 twice?

[Miss81 in reply to greygoose]

Exactly so how do I make the 24 hour gap when I take T4 at night?

[greygoose in reply to Miss81]

Please, write this question in a new thread. It's really not a good idea to attach your questions to other people's threads.

[Miss81 in reply to greygoose]

Ok I found this though by searching for the answers to the same question as this thread. It’s good if all the questions and answers are in one spot it’s actually easier to find but I will do as you say out of respect

[Miss81 in reply to greygoose]

Hi Greg goose I wrote the question as a new thread but no one is answering it. Should I ask you in my thread where we had a conversation before?

[greygoose in reply to Miss81]

Well, give them time. I doubt anyone's seen it yet. You do know this is just a patient-to-patient support group, sharing experiences and advice based on those experiences, don't you? There isn't a team of people just waiting to answer questions. But, I'm sure someone will be along soon that can help you.

[SlowDragon Administrator]

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Last 5mcg dose T3 approx 8-12 hours before test

How long before test was last dose levothyroxine

Suggest you retest correctly first

Depending on results you might need to add 2nd 5mcg dose T3 daily approx 10-12 hours after first dose

Retest 6-8 weeks later

[Miss81 in reply to SlowDragon]

Hi I want to ask why we need to adjust taking the meds at a different time before doing blood tests? Wouldn’t that be disruptive to the system and how can it be done anyways? Example, I take my T4 40mcg and T3 8mcg at 10pm just before bedtime. Then at 5:30am i take my other dose of T3 10mcg. And then my other T3 dose of 2mcg at 1pm. So my total dose is T4 40mcg, T3 20mcg. Now, how do I adjust this if I was to take a blood test? Paul Robinson talks in his book that adjusting it by 30min makes a difference to the system and here we are in general saying it should be adjusted before a blood tests? That doesn’t make sense to me because then the blood test wouldn’t be correct and or also the system would be mandled with if we adjust things before blood tests..? Can someone explain this pls ? Also if we take the meds at particular time of the day for a reason changing this just for a blood test would give results for the day of the blood test not the actual real result which would be if we take the meds as usual and do a blood tests.

[SlowDragon Administrator in reply to Miss81]

Because you want Ft4 and Ft3 results lowest possible for test results otherwise you risk endocrinologist reducing dose

[Miss81 in reply to SlowDragon]

Wouldn’t you want the actual real results though as they are. Maybe the dose should be reduced? No?

Also, I am taking T4 at night before bedtime, how do I make a 24 hour gap in order to do bloods in the morning?

[SlowDragon Administrator in reply to Miss81]

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

[LeiL]

I had the stomach issues and the right flank pain before adding T3 but it has worsened with the T3. I get burning in the bladder within minutes of taking the meds and feels like I have a UTI all the time.

[Gingernut44 in reply to LeiL]

Have you considered that it might be the excipients in your tablets. Can you try a different brand, possibly starting with your Levothyroxine as you suffered side effects before starting T3 ?

[LeiL in reply to Gingernut44]

Yes. I changed from the 100 mcg Synthroid tablets to two 50 mcg tablets. I’ve previously tried Tirosint and Tirosint Sol but I had severe GERD issues while I was taking that brand. I’m willing to try another brand but I just don’t know what might be better.

[Gingernut44 in reply to LeiL]

Changing from one 100 mcg tablet to two 50 mcg tablets possibly wouldn’t do much for you if it was the excipients upsetting you as you’re likely to be ingesting more by taking two tablets as opposed to one (I don’t suppose the 50 mcg tablets were half the size of the 100 mcg). Is there no way you could try a completely different brand ? I’m afraid it’s all trial and error.

[LeiL in reply to Gingernut44]

Supposedly the 50s lack the dye contained in the 100s. Tirosint is supposed to be the more pure but I couldn’t take the GERD.