I have always taken my levothyroxine around 4 to 5 am, whenever I am awake. Since introducing liothyronine it’s become tricky to time my second dose. The early am dose is fine: I just take it with the levo.
Since I’m a stickler for following guidelines, I am avoiding eating in the two hours before the second liothyronine dose, and for the hour afterwards. This is proving difficult, since each day my ordinary routines are different. To ensure there are three hours when I don’t eat or drink (I don’t allow myself anything other than water at these times) is really difficult, given my activities and social life! 🙄Am I being too rigid?
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Staffsgirl
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Paul Robinson in his book "The Thyroid Patient's Manual" from the chapter on T4/T3 treatment says this.
"T4/T3 can be taken on an empty stomach or not. However if you have any concerns about absorption, taking it on an empty stomach 30-60 minutes before food would be safer."
"Both T4 and T3 medication must be taken at least an hour or more before any calcium or iron supplement. If any iron or calcium supplement is taken, leave at least 4 hours clear before taking the thyroid medication."
Some people say that T3 is not as fussy as Levo so timing doesn't need to be so strict. It's really down to you, either be cautious or try a different routine and see if you notice any difference.
I take my T3 all in one dose with my Levo around 3-5am when I always need the bathroom, this keeps both well away from any food or drink or other medication/supplements except water.
We always say Levo should be taken one hour before food or two hours after, 2 hours away from other medication and supplements (although some need 4 hours).
The way I interpret is that we need an "empty" stomach for Levo to be absorbed, our stomachs are hardly likely to be completely empty unless we do a proper fast so my interpretation is more like "not too close to food" rather than "empty".
So if we take our Levo one hour before food that would be a few hours since last food then wait an hour before consuming any more food.
Or we can eat then wait two hours before taking Levo.
I am, of course, talking about Levo as I mentioned above, as you can see from other replies people have different ways of taking T3.
Thanks SeasideSusie for taking the time to answer. So, are you saying it’s ‘or’ or ‘and’ with regard to my original query? For instance, if I’ve left two hours after food, then take meds, would I still wait for an hour afterwards? And vice versa? That’s how I’ve interpreted it, but the original sentence is ambiguous, and has always puzzled me. Sorry🤔.
For instance, if I’ve left two hours after food, then take meds, would I still wait for an hour afterwards?
Very little Levo is absorbed in the stomach, it has to move on as it's mainly absorbed in the small intestine - the duodenum, jejunum and ileum. So you don't take your Levo then eat, it needs time to start it's journey through the gut so wait - ie " take Levo one hour before food" so that should give Levo time to move on so then you can eat.
And vice versa?
If you have eaten then it takes about 2-4 hours for the food to move from the stomach to the small intestine so you wait two hours before taking your Levo to give food time to start moving on.
Well you're the only member who has ever questioned this in the hundreds of times other members have stated the way to take Levo, so presumably the others understood it, or presumably they don't have meals within a couple of hours of a previous one.
Well, it was a genuine question…just to confirm it’s ‘and’ and not ‘or’. Sorry if that wasn’t clear. I wasn’t wishing to challenge the recommendation, just clarify it. Again…apologies for asking.
I don’t have meals as close together as the three hours necessary, but I might wish to have the odd cup of tea or piece of cake occasionally if I’m out with friends or similar! I’ve assumed even a cup of tea would not be advised? Maybe I’m just being too rigid with myself?
My T3 is taken 3 times a day - the first is with my T4 an hour before any food, etc early in the morning. The other two doses, I put it under my tongue and let it absorb sublingually, as I know it will absorb there - and then I am not so concerned if I am too close to food (sometimes my schedule is wonky during the day). This seems to work for me.
I was going to post the exact same question you posted, so the answers you have received are really helpful. I like you tend to be a bit of a stickler. I found Recon’s answer helpful to as currently I have to halve a powder capsule (anybody watching me would think I was dealing in serious narcotics!) and as T3 in starch has no taste - other than starch, I put the powder straight on my tongue and simply have a drink - it is water soluble.
Thank you for asking this question. I have the same issue. I need a snack mid afternoon so timing T3 to avoid food is very difficult. I might try dissolving it under my tongue.. hadn't thought of that.
Hi Staffsgirl. I think it's a combination of making sure you get good absorption of the medication and what works for you. I was meant to be on a split morning and evening dose of NDT on an empty stomach, but have found out that I cannot tolerate any meds after 1pm. It was trial and error discovering that! So I'm trialling a dose on waking and then again around 11 -- jury is still out on whether that works for me or not. Or even of NDT works for me.
If Im pressed for time I will take my levo/T3 30 minutes after eating and still time my other meds 3 to 4 hours after my thyroid meds no matter what and I have not had any issues.
Like others I take first T3 with Levo. at 6.30 - 7.30 an hour or so before breakfast- or brunch! My second dose of T3 I take at 10 pm regardless of when I eat. My only stipulation is to keep my T3 doses at least 8-9 hours apart so if I’m late taking 2nd dose (I have short term memory problems so despite an alarm going off in the kitchen by the time I’ve got there I can find myself making a cup of tea instead,! ) I take my T3 later. It took me a while to get it right and reduce dose due to palpitations but all fine now. I did try to have an afternoon dose but it was like adding another level of worrying about timing ...and I like to keep things as simple as possible.
T4 is the one to have on an empty stomach (I was only told this 30 years into taking thyroxine! ). but there are a few meds to avoid which can prevent absorption.
No. I do the same. 3 or 4 in morning whenever I wake for toilet. I used to take just before breakfast and didnt think was working and I got told to keep a couple of hours away from food drink and I think it made a difference personally.
I take my T4 at 7:30am and go back to bed for an hour so I don't eat or drink for 1 hour after that. But my T3 is not something I worry about. I take it when the time is due, regardless of eating or drinking. I often take the 2pm dose with lunch as that's when I'm likely to be eating. We don't need to be fussy with T3. Life's hard enough as it is. Cut yourself some slack.
I’m quite late in my reply but just in case it helps:
I had a similar question and with the help of these forums figured out a routine. (See post healthunlocked.com/thyroidu... )
Once I started using a dedicated medication app called MEDISAFE, I was able to get used to a quite convoluted and complex medication and nutrient regime.
My splitting of both T3 and T4 feels like it has made a difference. I’m less cold than I used to be, so I’m taking this as an indication that split tablets are better than not splitting.
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