I think I’m noticing a difference in how well I feel in relation to how early I take my Levothyroxine and wondered if anyone else had any insights on this. Annoyingly I awake naturally very early, say 5:30am. My normal routine is to lay there for a bit and then get up 5:45 and then take my Levothyroxine 6am & have breakfast 7:30-8am. If it’s a weekend, I try and go back to sleep and take my Levothyroxine say 8am. I then feel terrible all day, very groggy and hypothyroid. I don’t think it’s because it was delayed by a couple of hours, I’m wondering if it’s more to do with my natural cortisol levels being higher early morning (guess that could be why I wake up). Does anyone else experience something like this?
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TiredMummy
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Hi Slowdragon, yes I did reduce my dose as planned but it made me feel more hypothyroid. The jury was out as to whether my T4 was too high because I was having a Hashimoto’s swing or whether my dose needed reducing. Therefore, I am on back on 150mcg T4 daily and due to next test in 3 weeks time. If my T4 still looks too high then I’ll reduce it at that point. However, my awaking early and feeling groggy if I take my thyroxine late has been going on for many years regardless as to whether I was on 100/125/150 T4. I’ve always also awakened very early (it runs in the family and is the same for the women who don’t have Hashimoto’s). My question really was about why the timing was so important I guess. It’s something that’s happened to me for years and I’ve always wondered why that might be.
This is almost certainly linked to cortisol. Don't have a lie-in. Whenever you read anything about sleep and health they advise the same wake up time daily and the same bedtime when possible. Also, take your Levo at the same time. Have it next to the bed with a glass of water and take it immediately you wake up. That means you will be ready for breakfast earlier and able to get on with your day.
Can't comment on your cortisol but a few months ago I started splitting my dose. I used to need 2-3 coffees and at least 2 hours after taking my meds to come to life. I now take 125mcg T4 and 20mcg T3 daily. I take 25 T4 and 10 T3 at 8am. Water soluble vits at 10am. 50 T4 at 12pm. 25 T4 and 10 T3 at 4pm. Fat soluble vits and magnesium at 8pm and final 25 T4 at 12am. I have found a big difference in my energy levels in the morning and don't have the mid/late afternoon slump that I always had before so I'm going to continue. It can be a bit of a pain remembering but I set my calendar alerts to remind me. These are the times that fit round my main meal times so I mostly manage to eat at the right times to avoid the meds.
Having said that, have you had your bloods checked recently? It may be your dose that's the problem as SlowDragon pointed out.
Thanks Fatjellybean, that’s really interesting and I plan to look into split dosing once I get settled on a daily dose. I’m unclear whether I need T4 only or a T4/T3 combo at this stage, so best to get this aspect clearer first
This is really interesting as I am looking at this right now ! So you defo got benefit from splitting your T4!??
I’ve noticed a few ppl say they actually split their T4 dosing and it’s helping them. But many say there is no point. I know they say T4 is storage but if I stop my T4 I’m one of those who get sick at 4-5pm so splitting my dose might help me. I get hypo at night basically but days are great! ( I also dose and split T3 )
Splitting Levo is definitely worth an experiment for 6 months or so , to see how it goes . I split my levo . i used to do it years ago before i knew anything about the half life . I used to crash every day about 4pm and wondered if splitting it would help, so took half at about 2 pm.. i remember being convinced it helped at the time , but then a few yrs later later i stopped when i realised that it really 'shouldn't ' make any difference due to half life being so long ...talked myself into believing any difference was just placebo. However, the last couple of years i've started doing it again... i now take 50mcg before breakfast and 62.5mcg before bed around 11pm. (i've usually eaten dinner by 8 pm )
Interestingly since splitting it this time, my TSH has risen a little on same dose , which is useful as it keeps GP off my back , it was always very low . i'm fairly convinced this TSH rise is not a result of reduced dose due to less absorption when taking the later half closer to food , as i'm sensitive to quite small dose adjustments , and would notice fairly quickly if my dose is lowered by as little as 12.5mcg
like you, i can tell on the same day if i miss a dose.
My logic for splitting is simply that the thyroid doesn't naturally dump a whole days worth of T4 into the bloodstream in one lump , it gives us most in the early hours of the morning shortly after the TSH is at it's highest, so if we are still having some difficulties on levo ,why not try to replicate a bit closer what it does naturally, to see if it helps ?
By taking half of mine at bedtime , i'm just attempting to give my body a similar profile to natural T4 release.
When we take it all at eg 7 am, it then takes perhaps another couple of hours to get to the blood ,, so we get a massive increase at about 9 am, but we had lower levels than is natural throughout the very early morning... nobody really knows what difference this makes to how the whole body works.
I do also wonder if the TSH response to lower but more frequent doses may be subtly different to it's response to one large lump..... can't prove it though, as i don't have enough blood results. and have felt relatively well this last year , and increasingly better in subtle ways as time goes on , so i'm not prepared to change back to single dosing just to see if TSH goes lower again .
As for the 'it can't make any difference' school of thought .. the older i get and the more i learn , the more i realise that 'they' have basically no idea how the intricacies of thyroid hormones really work at all .. and nobody is more interested in doing proper observational research on me ,than ....me .
So if we're curious enough about something and try it carefully , we might just notice something they don't know .
'They' spent years telling me that 'all levo is the same'.... but i 've met enough people on here who feel just as yuck on Teva as i do, and who feel quite unsettled when taking different doses on alternate days , to know the conventional medics are not always correct about what they insist 'doesn't make any difference' .
Wow what a insightful and very helpful interesting reply!!! Finally someone who gets it ! I never felt good if I took Levo too late after 8am and I never felt good if I missed a dose by 4pm REALLY poorly ! I’m not an Endo so I can’t explain that but what you say makes sense to me! It’s a tool I’ve never tried yet but it’s something I’m willing to give a go as I’m seemingly good all day until around 8pm which feels like a T4 drop ( even when I’m dosing same good levels of my T3 evening too!)
Someone once also put my labs into some database thing and told me they can easily see I’m a “super” converter which means I convert too quickly which was interesting and may be why it felt like it drained out.
I get what you are saying tho - all this is still trial and error as we are all very different. If T4 has such a long half life for everyone then why is it Within 6 hours or not taking mine I would notice it. So either I’m a poor converter or something else is going on
Thanks for ur message I’m going to keep it as a tool in box if my current regime isn’t optimising me at night !
There could well be something else going on. There are enzymatic reactions to thyroid hormone. For some of us, if we take too much (either T4 or T3 or combo) at any one time we risk triggering enzyme D3 into converting the FT's to T2 and then excreting them. It's a defence mechanism to protect the body from too much hormone. Some people don't seem to suffer with it's effects, others do. I'm pretty sure it's been happening to me. The more hormone I take, the more hypo I become and my TSH has been creeping up, which is bizarre.
It stands to reason that if you are susceptible to this reaction, breaking up the doses into smaller chunks throughout the day may mean this reaction doesn't trigger, and therefore you get more benefit from the hormone you swallow.
I'm basing this on the information within this article:
Yesssss this is exactly why I feel sometimesI do feel over medicated and my body is confused yet testing doesn’t show this but hormones go up and down all the time so it’s tricky! I’ve just taken out 25mcg of my T4 and already I feel less dizziness and head fog but still not optimal using T3 just yet at night I’m still hypo even tho day times are pretty decent ! I too have looked into the D1 gene and have the test here to do to see if I do have this issue so I will post up here my results in next 3-4 weeks but apparently takes 4 weeks to come back!
You are getting enzymes and genes mixed. D3 enzyme converts hormone into something our bodies can't use if it thinks we have too much. Dio2 gene faults can cause a problem converting T4 into T3. I suspect that's the test you are going to do. I have inherited the Dio2 defect from one parent.
exactly,.... if T4's role is strictly limited to 'long term storage and transport with effects that are only noticed cumulatively over about a week ' then it should not be possible that when i forget a morning dose i would be behaving and feeling different in subtle ways by about 2 pm, and be a zombie by 7pm , and the next morning feeling so messed up and scatty that i'd invariably forget the next mornings dose too. ....... but that is definitely what used to happen... so much so that other people could also tell the difference and were asking me if i'd taken my tablet.
I eventually got to read myself well enough that i can now tell by 2pm if i've missed a mornings dose...... My thinking is disjointed , I realise i'm temped to push on and work through lunch which i shouldn't do , and i notice i'm talking too much and desperately want a fag , even though i don't usually allow myself one till after my evening meal , it feels kind of like i'm running on adrenaline.
Yep exactly what happens to me - always noticed missed dosing ! I’m praying my current regime will settle me down but I will split the T4 and trial it in a week or so if i still can’t get right in evenings. Worth a try!
I'm definitely feeling the benefit but not sure I can add much to what tattybogle perfectly said. I too had heard others say they were trying it and decided there was nothing to lose. I just had to sit down and work out the best times that worked for me with meal times and supplements. Someone else on here (sorry don't remember who) said that splitting had helped to raise their TSH slightly without affecting fT3 or fT4 levels. I also read a research paper (frontiersin.org/articles/10... that looked at the frequency of taking combination T3/T4. (I have the Dio1 polymorphism that they discuss) and found that fT3 levels fluctuate less throughout the day the higher the frequency of the doses. So I figured it was definitely worth a go at splitting it as much as I can conveniently do.
Wow yes this is great information and any small changes to TSH like that can be beneficial to is especially when it helps us with the keeping docs Happy etc etc …but yes I know which thread you mean I read that also! The link looked great but I couldn’t get it to work thanks x
Sorry Anon_77 don't know what happened there. Here are 2 links to the full paper. It's called Optimal Hormone Replacement Therapy in Hypothyroidism - A Model Predictive Control Approach. Hopefully these work.
Like FAB-jellybean i also split my levothyroxine (and T3)
I only started splitting levothyroxine about 6-8 months ago…..and find it significantly better
I split levothyroxine as 1/2 dose at 6.30am (set alarm and then go back to sleep) and half dose levothyroxine at bedtime
T3 doses at 6.30am, 3pm and bedtime
I tried splitting levothyroxine as 3 doses, but didn’t notice any difference compared to two doses….and 3pm dose levothyroxine interfered with afternoon tea time
Since starting splitting levothyroxine I feel less stressed, don’t crave sugar and have managed to loose almost 5 kilo
Wow this is amazing to hear that you also feel this makes a difference to your levels ! It’s a tool I’m going to try I think if the protocol I’m doing atm doesn’t work still. Because I’ve just taken out 25mcg of Levo and trying to increase some T3 atm so need a week or two to see if that helps me but it’s always at night I’m getting the issues so it is something I might play with later ! My idea is that My doc say you do absorb a small amount of T4 at the time of taking it there for it must have some effect even if small 🔎
Really should stick to same time every day for levo …I take mine at 5am and fall back to sleep for 2 hours …I wear fitness watch that has alarms set for meds.
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thanks x 
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