Hi all
I saw my Endo yesterday and he’s recommended putting up my T3 from 2 x 5mcg per day (morning and 2 hours after lunch) to 15mcg per day.
His suggestion is 10mcg in the morning and 5mcg after lunch. I know some on here recommend 3 even doses throughout the day but the Endo was insistent I do 10mcg in the morning as he feels people who take T3 at night can’t sleep.
Would be interested in views on here from those who have tried both approaches.
My latest blood test results are shown here:
They will keep thinking T3 is like speed……many, many members find 5mcg at bedtime gives excellent sleep
But it doesn’t suit everyone
You could try 5mcg at 6am, noon and 6pm (that’s what my endocrinologist recommended when initially started )
Then experiment with spreading timings……
I found I preferred last dose later by accident, approx 8-10 weeks after starting T3…….when had to move last 5mcg dose before blood test to 8-12 hours before test ….
personally I take 5mcg at 7am, 5mcg at 3pm and 5mcg at 11pm
I also split my levothyroxine mainly at bedtime (100mcg) and rest at 7am (5 days 25mcg and 2 days 12.5mcg )
Looking through previous posts can’t see any recent results for vitamin D, folate, ferritin and B12
What vitamin supplements are you currently taking
Presumably you have Hashimoto’s?
I take 1 dose as I wake and the second dose at bedtime. no problems. Do what you think best for you and don't tell the endo.
I've always taken T3 once daily.
I follow the advice of an Adviser to thyroiduk who died through an accident.
Dr John Lowe was a scientist/doctor/expert on the use of T3 and would never, ever prescribe levothyroxine. He also took T3 himself and it allowed him to pass his exams and have a good career and loved by his patients.
He would also prescribed NDTs (natural dessicated thyroid hormones) to his patients that were first given in 1892 and from then on it saved thousands of lives.
Unfortunatley, in the UK, this has now been withdrawn from prescriptions (it made me wonder if whoever made this decision had undiagnosed hypothyroid as they don't appear to think straight).
Dr Lowe's recommendation was a once daily dose as it then saturated all of the T3 receptor cells and then sent out 'waves' throughout the 24+ hours. It means my life is completely normal after I take my a.m. one daily dose.
ndnr.com/anxietydepressionm...
p.s. I did a test on myself:-
I took one daily dose. Took none on day 2, and then none on day 3 and I was fine and had no symptoms.
Silly man! At one point I was taking 225 mcg every night before bed, and I slept like a log! Ask him if he's ever actually taken it himself. If not, on what does he base his theory?
Well he actually said this is based on some patients of his who can’t sleep if they take T3 at night. Must be some truth to that.
The only way to find out is to try. So much of thyroid hormone dosing is trial and error. It has taken me 2 years to sort out my combo doses and timings.
based on some patients of his who can’t sleep if they take T3 at night
“Some” being the important word ….not all ….likely a minority
Taking T3 posibbly worked too well on the given dose and pushed them temporarily into overactive thyroid.. it takes 3 months for the body and brain to adjust to dose changes but 14 days to remove completely.Reverse T3 is the final piece of the jigsaw that, shockingly, never gets tested!
Tsh tests the pituitary gland.
T4 and a tiny bit of T3 is released.
T4 then gets converted to T3 if conditions are right.
Then they get converted to usable in the blood..
Free T4 and Free T3.
If conditions are right then they are used by cells.
Any excess is removed by Reverse T3.
What if reverse T3 isworking too fast? It never gets tested so how do we know.
Diet, nutrients; such as selinium(a few Brazil nuts daily, omega 6 (oily fish) vitamin D3 (Sunlight) all contibute to healthy thyroid function.
Many say gluten free helps.. prob because we are eating wheat/gluten/pesticides 3 or 4 times a day.. it's becoming like insulin resistance.. our bodies give up dealing with it.
Peanuts, soy, miso and uncooked cruciferous green veg all LOWER thyroid function and make you more hypothyroid (great if you're overactive.. gets you back to normal)
Iodine in sea salt, and seaweed products raise up the thyroid
Carefully increase.. things that change hormones need to be adjusted slowly and given time for body to adjust and settle.
Hope this helps x x
Linda (8 years research, 10 docs, 5 Endos later!)
I see you and I raise you: 11 private Endos!!!
Rubbish.!
T3 misunderstood...again.
The man needs to go to T3 school.
Bet he doesn't live/ struggle with thyroid disease every day.
Yet during a brief appointment, staring at a computer screen...
He can tell you how you feel.
Little wonder so many thyroid patients are struggling.
I need high dose T3-only to function ( has been 212.5mcg) and take it in a single dose at bedtime.
No trouble getting to sleep.
Clock watching all day to multi dose would drive me round the bend....
But, importantly, we are all different!
It can be trial and error...
Hope you find your best dosing protocol.
There are no "rules" written in stone.
I find it best to even out the doses during the day. This gives me the best response for the lowest dose - I can get the same response by taking L-T3 early in the day but I need more L-T3 for the same benefit. I find that bedtime dose is the most effective, when I'm on enough my sleep is deeper and I feel better the next day.
If I take too much L-T3 I find it difficult to get to sleep. If his patients can't sleep taking L-T3 (or NDT) at night then they are on too much! On an optimal dose I get to sleep reasonably easy, don't wake up too much and my dreams are 'sharp' and 'in focus'.
How much T3 someone needs is complex and no doubt relates to the underlying reason they are hypothyroid.
When I increased to 15 mcg T3 daily, I was also advised to divide it as 10 mcg morning and 5 mcg after lunch. (from 2 x 5 mcg) That's what I did and it had a marked effect on TSH. I wonder if 3 x 5 mcg would have had less of an effect on TSH but give the same benefit. I see your TSH is already low, but not completely suppressed. You and your endo may not be fussed about TSH, but when mine went undetectable it became a topic of conversation and a distraction I could've done without.
You could try 3 x 5 and see how you get on. You'd know straightaway if it interferes with sleep. I tried thyroid meds at bedtime but didn't really see any benefit. I like to be able to take other things at night, so I went back to daytime dosing. If it improved the quality of your sleep along with symptom relief, that would be brilliant.
wellness1,
I too have often wondered if a smoother T3 level (avoiding peaks & troughs) would encourage a slightly higher TSH. TSH should be daily variable but with our dysfunctional thyroid signalling and forced medicated thyroid levels it would make sense that a sensitive TSH would no doubt drop to its lowest in response to the T3's highest peak but once there risk being difficult to induce back to its highest. Do you have any thoughts on this please jimh111
The fallacy of the TSH actually doesn’t matter to me because I self medicate and only 9mcg T3 a day (within 1 grain NDT). Adrenals/adrenaline still dictate I have to multi dose am & pm which I don’t mind as believe the more even spread allows a lowest dose achieving wellbeing and so less likely to interfere with other systems such as raising SHBG, etc.
Wired123 I have experimented & taking my meds just before bed has made no difference to my night time sleep. However, splitting them am & late afternoon has helped alleviate that late pm slump.
Nobody knows whether TSH responds to the peak, minimum or average fT3, fT4 levels. I don't think it has ever been tested. As TSH responds rapidly to changes I suspect it will respond in part to peak levels and the fall in TSH may lag a little. This image shows this happening thyroidresearchjournal.biom... . The original study is behind a paywall, hence I've taken the image from another paper. In the original study they replaced 50 mcg L-T4 with 10 mcg L-T3, so you can see what happens to TSH when you take 10 mcg L-T3.
jimh111,
It is interesting this hasn't be investigated considering the requisite given to the retention of ‘reasonable’ TSH levels, (rightly or wrongly). Yes, I knew about the lag and greater TSH fluctuations influenced by T3.
Thank you for the graphs.
waveylines following from conversation the other day re. testing at 12hrs vs 24 hrs for T4/T3 combo's .. you might find the above graph that jimh11 links to interesting ..
With T4/T3 combination therapy it looks to me like TSH and fT4 and fT3 levels are all pretty stable after about the 12 hour post meds point. ( image bit blurry jimh111 can you confirm ? ) combo group is:
Top line Graph A
Bottom line Graph B
Top line Graph C
(It also looks like they didn't give the poor old T4/T3 combination group a big enough dose ... TSH is 5/6 ish ! )
Yes. This is a link to the original study, it's behind a paywall but the image is available for free semanticscholar.org/paper/T... .
Figure 2 shows that the percentage change in TSH is the same for mono and combination study. Also, if you look just to the right of 'View on pubMed' there is a link to a free copy of the study.
This study is from 2007, before Celi found that L-T3 is 3x as potent as L-T4 and this explains why they used a 5:1 ratio.
Thankyou jim
Thanks Tattyboogle &Jim thats interesting though am no good on analysing scientific papers tbh..I'm not sure how this resolves the 24hr testing with its ranges and the idea you should test after 12hr & whether ft4 test of a 50% reduction in time is as valid. I wouldn't want to show the results to my GP.
The scientists seem obsessed over the negative side effects of T3 & determined to.proof its no good......despite so many feeling better on it! T3 spikes can be reduced by lower doses & higher frequency of taking. Thats certainly what I had to do on synthetic T4/T3 BUT not when I started taking a NDT. I dont think NDTs should be lumped to gether with a synthetic combination. they are different....just my opinion, no science to quote to back it! Sorry!
I used to take T3 at night and what I found is that if I took it and then fiddled around getting ready for bed, or reading etc, I would become wide awake and then could not drop off to sleep but if I lay down in bed, all ready to drop off and then took it and actually let it dissolve under my tongue, I was fast asleep in minutes and slept well all night. That was when I was on T3 only regime and I am now back on T4/T3 and no longer take T3 at bedtime.
Perhaps because T3 peaks three hours after taking liothyronine. I take my liothyronine as I go to bed so I have peak T3 when I need it most during deep sleep.
Hi Jim do you take your thyroxine in the morning and T3 at night ? as was thinking of doing that to spread the dose.
I split my liothyronine between breakfast time and bedtime. I take my levo in the morning.
Thanks for everyone’s opinions and experience. I see it ranges from all at one time to spreading it evenly across the day with logic to support both extremes.
I think I’ll try even spread first and see how that impacts me before fiddling around more.
I am on 15 mcg T3 and 125 mcg T4 and find that if I take the T3 before bed I can’t sleep. My latest TSH was 1.17 so I am not at all overdosed. I think everyone is different and would suggest you try different combinations to see what works for you. Your endocrinologist sounds good to me and I would personally do him the courtesy of starting where he suggested. He has not only given you T3 but also suggested increasing it and sounds as though he is flexible and has your welfare at heart.
I really don’t think comments like “Silly man! ”, “ Ask him if he's ever actually taken it himself. If not, on what does he base his theory?“ or “ Rubbish.!
T3 misunderstood...again.
The man needs to go to T3 school.
Bet he doesn't live/ struggle with thyroid disease every day.
Yet during a brief appointment, staring at a computer screen...
He can tell you how you feel.
Little wonder so many thyroid patients are struggling.“ are fair or helpful. We don’t know if he had his head in his computer or if he has thyroid disease himself.
Give the guy a chance, he could be right.
Much of your response appears to refer to my comments on this post.
Wired 123 said...
Would be interested in views on here from those who have tried both approaches.
Those are my views, the result of decades of wrong diagnoses and wrong treatments by medics. Thanks to support from the experienced and knowledgeable members here I have been able to discover these were the consequence of low cellular T3 caused by a form of thyroid hormone resistance. Long story!
So, forgive me if I have strong views borne out of decades of miserable experiences....and I know I'm not alone in this
Bet he doesn't live/ struggle with thyroid disease every day.
Yet during a brief appointment, staring at a computer screen...
He can tell you how you feel.
Little wonder so many thyroid patients are struggling.
I wonder how often do medics ask " How do you feel"?
How often do they employ clinical evaluation?
How often do they simply rely on ( inadequate) lab results on their screens?
How often is that their only route to diagnosis?
Why did I write that?
We live day in day out with this debilitating condition yet how often are patients diagnosed and treated during a brief appointment by a medic who has never seen them before or one who barely knows them beyond a few lab test results
The consequences of that are underlined by well over 120,000 members here who have arrived looking for the help and support they need to recover. ...but which has been denied them!
You will also note that I pointed out -
But, importantly, we are all different!
It can be trial and error...
Hope you find your best dosing protocol.
Give the guy a chance, he could be right.
I don't know about you but I don't see medical treatment as a game of chance.
I would be looking for an experienced and knowledgeable practitioner who would be (at least for the greater part) right rather than one who maybe "could be right".
Just because someone has a medical degree doesn't make them experts in every field of medicine. Thyroid disease is poorly represented; there are few experts.
Not always their fault because they can only work with what they are taught at med school and with what has particularly grabbed their interest!
They need to acknowledge this. I had a GP say to me recently, " I just don't know", he earned my respect for his honesty! Not many have the confidence to admit that.
And one who doesn't make sweeping general statements such as -
he feels people who take T3 at night can’t sleep.
That is rubbish as further reading of comments will show.
Yes, he has prescribed T3 which is wonderful but he clearly doesn't understand how it works....and without that understanding it is likely that the patient is set to fail.
Wired123 has asked for other people's views and experiences. Do you think that request indicates she is entirely convinced by this medics advice?
In responding I have offered no advice, I have expressed my views and I'm sure Wired123 is capable of making up her own mind about how she wishes to go forward.
I'm sorry if you feel that I have not been "fair or helpful" but I stand by my comments!
PS Your TSH may be 1.17 but what is your FT3 which is an accurate indicator of overmedication...or undermedication?
I'm pleased that you are keeping well.
Can I just say this is my 11th Endocrinologist, I've seen all the "best" people in London on Harley Street including Professors (and that includes the one who was policing other Endos and investigating them when they prescribed T3).
My current Endo does indeed go by how I feel and spends a lot of time discussing things. There's a reason I've stuck with him for some time and he truly is the best I've seen.
I'm sorry you've had such a challenging thyroid journey and hope this endo achieves improvement for you. Your journey underlines the problems that thousands of patients experience when searching for the answers to what has caused their ill health.
My heart goes out to you given that the "best" practitioners in London have so far failed to improve your quality of life. I wish you well and hope number eleven has the extensive knowledge and experience which enables him to make you well.
I gave you my views but they were opposed by Mollyfan who considered them neither "fair or helpful"....that was of course her prerogative.
I'm not sure why she inferred that the following was expressed, "We don’t know if he had his head in his computer",...unless the text was misread. That phrase was not used by me.
I responded as I did in order to explain my comments to Mollyfan
You had asked for member's views; I gathered this was because you had doubts about the advice that you have recently been given by your new endo.
You will have read my comment to Mollyfan that,... In responding I have offered no advice, I have expressed my views and I'm sure Wired123 is capable of making up her own mind about how she wishes to go forward.
Good luck!
When I’ve been unable to sleep, I’ve taken 5 in the early hours to send me back to sleep. I think the trick is to choose a pattern and stick to it as you body starts expecting it at a certain time. So split it over two or three bits across the day. Or… just take it all in one go as I and many others do. Think it’s just whatever works for you. Trial and error.
I found taking 5mcg every 8 hrs or so worked well for myself. 7am. 3pm. 10pm. I slept well too.
I did have to reduce to twice a day when I stopped going the gym during the pandemic. Currently I take 5mcg 7am and 3pm. Plus Levothyroxine liquid I also split my dose twice a day.
My T3 dose between 2am and 4am definitely helps me to sleep better.It’s trial and error.
I used to take 5mcg an hour before lunch and 5mcg at bedtime. But I found I lacked energy in the mornings.
When I moved my dose to 2-4am it made a big difference.
I now take a dose at approx 5pm an hour before my dinner too.
I dose with T3 before bed time and sleep very well. I dose with my T4 in the morning. It sometimes take time for the body to get used to dosing with T3 before bed time. I find that I have more morning energy when I dose before bed time. Some on T3 sole take their full T3 dose in one gulp before going to sleep. And do very well. It's really trial and error. But it's good to try and give it some time to see which way works best for you.
Hi 
Can I ask how much do you take? Thank You
Hi. I dose now with 15 mcg T3 bed time. This works best for me. T3 has made me feel tired . Switching to bed time dosing has made a huge difference.
Won’t know until you try.
I take my T3 in 2 doses, one directly before bed.
I have never had a problem with insomnia since I started taking T3. When on levo - since 1999 diagnosis - I couldn't sleep for toffee and T3 has given me the the best life since I started taking it in 2020.
However, if I were you I would trial my largest dose before bed and the other when I got up.
What the Endo doesn't know won't hurt him.
Try it and see how you go on. I believe some have found that it doesn't suit them, but all I can say is try it and see. Good luck with it.
Thanks. The Endo has actually allowed me to experiment as he says it’s what works best for the individual that matters but it’s just his view that some patients struggle to sleep if they take T3 at night. It’s interesting to see the diversity of opinion on this topic on the forum which shows there’s not one right answer that works for everyone!
I take 25mcg T3 & 50mcg T4 as late as I can. I sleep like a log & wake up with a smile. You won't know if it suits you unless you try.
Results and T3 increase 
T3 what amount per day do you take 
