Is taking 5mcg T3 in the morning then 2.5mcg in the evening sustainable long term. Do others dose differently morning and evening?

[Piglet1956]

Hello everyone,

Following on from my previous post a week ago, I have reduced the Liothyronine dose from 10 to 7.5 mcg per day starting on 15th May.   I take 5mcg am and split the capsule for the pm dose.

This is in addition to lowering the Levo from 100/75 on alternate days to 75 every day. It’s probably not ideal to do both at the same time but I can’t cope with the palpitations I’ve been having and I know reducing T3 slightly will have a faster effect on heart rate than reducing T4 by a minuscule amount. 

I feel that a T3 level of 83% through the range is too high for me.  I have had a slow metabolism for as long as I can remember so have likely been a poor convertor of T4 to T3 (DIO2 inherited from one parent).  I feel my heart is happier with a lower level than at present. 

For ease of reference my last three sets of blood results are pictured above.

I saw my GP about another issue and mentioned that my Levothyroxine prescription needed reduced to 75mcg daily and also advised I was going to reduce Liothyronine.  He offered to gave me a prescription for 2.5 Liothyronine and I was ecstatic.  However something got lost in translation, and when I collected the T3 I’d been given 112 capsules instead of 56, i.e. reduced from 5 to 2.5 T3 morning and evening. The Roma 5mcg has been replaced by the 2.5mcg capsules. I was looking for 56 x 5mcg capsules and 56 x 2.5mcg capsules. Before I try to sort this all out with the GP pharmacy I would like to be clear about what I’m asking them to give me, hence this question.  Mixing and matching seems not to be an option for them.

I hope this is clear to you and thanks for reading. 

[SlowDragon Administrator]

Perhaps try 2.5mcg as 3 doses per day

Waking, mid afternoon and evening

Who makes 2.5mcg capsules?

[Piglet1956 in reply to SlowDragon]

Thanks for your reply. They are in a tub marked Xeal PHARMA. Would it be unadvisable to take 5 mcg in the morning (6am ish)and 2.5 in the evening (5:30pm ish) or is it worth trying. I feel my life is restricted enough as it is trying to fit in and space out all my vitamins and minerals.

[helvella Administrator in reply to Piglet1956]

Xeal is a specials manufacturer. Not a regular product.

We are Xeal Pharma

Want to know about Xeal Pharma?

Professionals in the manufacturing of “Specials” medicines, bespoke pharmaceuticals and supplements.

Xeal Pharma is based in Birmingham. The company was founded by four pharmacists who have combined their skills to offer a comprehensive service to the healthcare industry.

We supply manufactured products to pharmacies, hospitals, clinics and wholesalers in the UK and Ireland.

xealpharma.co.uk/

[Piglet1956 in reply to helvella]

Thanks for looking this up. I suspect they cost an arm and a leg.

[helvella Administrator in reply to Piglet1956]

Maybe - but quite possibly not as much as some other things - like Mercury Pharma liothyronine a few years ago.

[Lalatoot]

I dosed 2.5mcg lio 3 x day for a while but I found that the afternoon dose didn't suit my routine (tea and cake time!!) For the last 2 years I have dosed 5mcg morning and 2.5mcg bedtime and find this suits me well. I am also on 2 x 50mcg levo daily which I take along with the lio. These doses make my tsh undetectable, my ft4 50% at its lowest and my ft3 around 72 - 77% at average.

Knowing I take 2.5mcg dose my GP allows me to continue to get 5mcg Morningside lio which split easily.

[Piglet1956 in reply to Lalatoot]

Thanks for your comments Lalatoot. I just don't know how to proceed but its good to know you have a reduced evening dose and it works for you.

[SlowDragon Administrator in reply to Lalatoot]

I currently take 15mcg as as 3 x 5mcg doses

Schedule

5mcg T3 and half my levothyroxine at 6.30am….then go back to sleep

5mcg T3 in afternoon…..timing moves around a bit ….usually 2pm ish ……but if had late lunch I move later

5mcg T3 and remainder of levothyroxine at 11pm

Considering reducing bedtime dose T3 to 2.5mcg

But would have to get GP to agree to new prescription

I currently take 15mcg per day Morningside T3 as 3 x 5mcg from a 20mcg tablet cut into 1/4’s

Cost to NHS currently £38.50 per 28 days

If reduced dose

Options are

5mcg tablets cut in 1/2

Cost to NHS £60.25 per 28 days

Or

10mcg tablets cut into 1/4

Cost to NHS £38 per 28 days

Plus half a 20mcg tablet as 2 x 5mcg per day

Cost to NHS £25 per 28 days

[Piglet1956 in reply to SlowDragon]

Its so complicated. I so wish they would just give us the medicines we need or the opportunity to try different forms/variations of T4/T3 combinations, including NDT

[Lalatoot]

Piglet you just have to do trial and error. The body likes a stable dose so try to stick with any decision you make as long as you can. I found that even after 2 years on stable doses , I am still seeing improvements.

[Piglet1956 in reply to Lalatoot]

My endo reduced T4 from 100/75 alternate days to 75 every day. I waited just 2 weeks to reduce evening T3 dose from 5 to 2.5. That was 4 days ago. Perhaps I should have waited longer but I had no faith that a daily drop of 12.5 msg T4 would stop the palpitations. And I haven't yet advised him of the change 😔🙄. Palpitations have lessened but it may be my powerful imagination as it was very soon after the reduced dose. I'm saying this as perhaps I should return to the 5mcg evening dose the endo thinks I'm on and wait to see if palpitations return/or reduced T4 does the business, given your very valid point that the body likes stability.

[McPammy]

I take 5mcg T3 liothyronine when I wake up about 7am. Then my next dose of 5mcg around 3pm. My bloods are always in range. Midway without taking T3 prior to blood draw and usually 5.6(3.7-6.00) after taking it. My TSH is normally around 1.00. I also take liquid levothyroxine and split my dose. Half at noon. Then then theb2nd half at 4pm. A bit of a faff but it works well for me. I have taken my levo going to bed also I found that my levels went up. Maybe better absorption at night.

[Piglet1956 in reply to McPammy]

Thanks for your reply. It seems to be trial and error McPammy. Its the error bit I'm not so keen on but I will try a reduction and see how it goes.

[radd]

Piglet, 

There are no hard and fast rules, just that some of us need to split our daily total T3 dose to reduce peaks and prolong its action.  

You can experiment with these doses and see which beings you most well being and that fits well into your daily routines, and starting with 5mcg T3 in the morning with 2.5mcg in the evening is an excellent start.

[Piglet1956 in reply to radd]

Thanks Radd. I guess I will give the reduction a try since I have the meds now anyway.