Splitting T3 dose

[27ah]

After what seems like ages and with very slowly making changes I think I may be on a good dose for me. I'm on 112.5mcg thyroxine and 20mcg T3. I haven't yet done a blood test but I feel like me again. I have tried going up a little on the T3 but it didn't work. I am taking 10mcg of T3 and 112.5mcg of thyroxine at 5am and 10mcg of T3 at 2pm. Whilst I feel well mentally and physically in the morning when I wake up at 6 ish, and well all morning and early afternoon, in at 4pm ish onwards I start to flag and by 7pm I'm really struggling and feeling quite hypo. I am considering splitting my dose further. I have tried a small dose before I sleep but my sleep was affected. It was only one day though and a few months ago. I thought I would revisit when my dose was settled. I have also tried 10mcg 5am, 7.5mcg 1pm, 2.5mcg 4pm. It didnt affect my sleep but didnt make the evening easier. My question is how should I try splitting? My t3 is prescribed as 10mcg tablets.

[SlowDragon Administrator]

You could try

10mcg waking, 5mcg 2-3pm and 5mcg at bedtime

Or

10mcg waking, 5mcg 2-3pm and 2.5mcg 6pm and 2.5mcg bedtime

Many people find 5mcg at bedtime improves sleep, but some people find it keeps them awake

[27ah in reply to SlowDragon]

Thank you for your reply. I will tinker with my doses and see if it makes a difference

[SilverAvocado]

I think splitting a dose is really just trial and error. I now split mine into four. Three doses during the day and one during the night. Each time I added an extra split I felt improvement in symptoms, and not only directly after the dose, but during the rest of the day, too. I am definitely an advocate for trying extra splits.

I think the main indication you need a split, or that the distribution across splits needs adjusting is just as you describe, feeling much better or worse during some times of the day than others.

For me, being able to squeeze in a dose far enough from food leaves me quite limited in slots available in the day. I take my doses on first waking, wait an hour to eat breakfast, then another dose two hours after breakfast, then two hours after dinner, and finally whenever I wake up in the night.

My morning dose is the largest, night time dose the second largest, and the doses later in the day are small. But it's also constrained by how much I can split tablets.

If I were you I would figure out what fits in with practicalities. Two hours after an evening meal could make sense. If that makes it too late for you maybe you could try having that meal earlier to bring it farther from bedtime, or midday meal later, (or reduce the size of that evening dose).

For a long time I only ate twice a day as it made more sense with squeezing in doses.

In general I suggest persisting for a week or two with any changes, as strange symptoms can always come up immediately after any change in dose.

Oops, I've just seen you'd trialed a 4pm dose and it didn't make much difference. My suggestion would be to try increasing the size and waiting a week or two and seeing if it does have more of an impact. Maybe try 5mcg.

This is all trial and error. There is no correct or wrong way to do it. You could even try to carry on having two doses, but move the second dose to the later timeslot at 4pm - it would move you closer to an even distribution across the whole 24 hours of the day.

All you can do is try different options, stick with it for a few weeks and see if you feel any improvement. Make some good notes on each thing you try.

[27ah]

Thank you for your detailed reply. I think I'll try splitting further for a few days and see how I go. Slowly Slowly is the way to go, I get that. And a good idea to note down how it went each time.

I hadn't thought of doing 2 doses evenly split in the day. It sounds sensible and more straightforward. Might try that in a week or two

[marinria]

I split my T3 and my Levo as well. I find it gives me a more even energy throughout the day.

[username9]

Find what works for you. Ray Peat says T3 doses over 10 mcg will get deactivated by the liver. I take five 30 mcg T4/7.5 mcg T3 daily about every three hours with food, except first dose in bed. My temps have improved but are still not there. I need extra thyroid when it's really cold. Peat says some people can need 4x as much in winter. Keep a log of your temps, pulse and symptoms.

[Poniesrfun]

You could try taking your levothyroxine at bedtime then wait and see when you begin to flag in the morning getting up. If you wake at seven then start to drag around ten, then plan your morning dose at around 9 am. Then schedule your afternoon dose four to six hours later – at least 30 minutes to an hour before you would normally begin to lag. Or step it as 5 mcg four hours later then another 5 mcg in two to three hours.

If you go back to Paul Robinson's early stuff where he talked about circadian rhythms - you have a boost from your cortisol in the am coupled with whatever T3 was converted from your bedtime levo, so if you take your first T3 too early you'd be kind of wasting it.

When you're experimenting do the experiment for a solid four days before deciding if it's going to work or not. That gives your body time to adjust to the change.

Patti in AZ

[27ah in reply to Poniesrfun]

Thank you for this. Does you take only thyroxine and no t3 before sleeping? I take ramipril before sleeping. I wonder if that would be a problem.

[Poniesrfun in reply to 27ah]

According to the Synthroid (brand of levothyroxine) prescribing information, ramipril (and medications in the same class) is not listed as interfering with your thyroxine. I take desiccated thyroid, so yes, I am getting T3 if I take it at bedtime.

Regarding a "prewaking dose of t3" – if you take your thyroxine at night, your "normal" circadian rhythm may increase conversion of T4 to T3 in the pre-waking hours. Not guaranteed but it might occur, meaning you wouldn't need to take your first T3 dose later in the morning. You need to try for a while and see how you feel upon waking.

Yes - there are a lot of variables which is why we need to try one change at a time and give it a fair chance – three or four days or longer – to see if it will work.

[27ah]

It seems I need to do some trials, leaving for a few days and seeing the impact. Thank you for your replies. I now have some ideas I hadn't thought of.

I'm currently trying 10mcg at 5am then 7.5 at 1pm then 2.5 at 4pm. Will see how that goes.

I haven't ever tried taking thyroxine at night and have seen several posts where people say it helps. When people do this do they still take a prewaking dose of t3?