If you use NDT and you dose it twice a day, how much of a gap do you leave between the two doses? And how do you determine how much to take in the first dose and how much in the second?
I've tried once a day and it doesn't work for me. I run out of steam.
I've tried three times a day, 8 hours apart, but I don't think that's really working either in that I don't have enough in the day but if I add more I seem to have too much in total.
So now I need to give twice a day dosing a decent stab and see where that takes me.
My current dosing of Armour is: 8am 1+1/4 grain. 4pm 3/4 grain. midnight 1/2 grain. 2+1/2 grains a day total. I am feeling a bit better and getting more things done from 4.30pm to around 7pm and then I get weary. Mornings were good at first when I added the 1/4 grain to my 1 grain. But that effect has worn off now and I am mostly just slow and sluggish and tired.
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FancyPants54
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I take 1 grain when I wake up and 3/4 grain around 3pm. If I take it any later I find it difficult to get to sleep as my brain goes into overdrive and I lie there tossing and turning for hours.
Sometimes I wake in the night with anxiety and if that happens a bit of T3 calms it straight down and puts me back to sleep in 20 minutes. I have never felt too awake to go to sleep because of it. It's so strange how we are all so different.
It sounds like your split is probably about 8 hours apart like mine. Thank you.
I have tried split dosing but find it works fine for me to take it once a day - I’m also on 2.5 grains. I can even miss a dose for a day and feel ok. I wonder if you aren’t on quite a high enough dose? I used to run out of steam when I wasn’t on enough.
Hi Clarebear I haven't noticed you around for a while here. I'm assuming that's a good sign and you are doing well.
I don't think I am on enough yet. But the 3 times a day dosing might have been making an increase harder as there was never space for enough ebb and fall of the hormones. If I can get settled OK on twice a day I will try another increase again. My recent bloods are nowhere near too high.
I really, really wanted once a day to work. But it was all over by 3pm when I tried and I felt really anxious as the evening progressed. I do think I might have experienced some D3 enzyme action neutralising some of the hormone when I took it all together. I have to watch for that.
I tried taking a dose when I wake up and a second dose around 4PM, 1 hour after eating. I must say this hasn’t worked at all for me, I keep ending up very tired in the afternoon. So I went back to what I used to do, which is one dose at 5AM and the second at 1 PM, before I have lunch (which is usually around 2PM). But I also take calcium twice a day, which needs to be 4 hours away from NDT, which makes finding the best time difficult. I guess you need to find what works best for you. I thought taking a dose at 5AM would be a waste of the T3 that is in NDT, but my body either got used to that or that is indeed what works for me 🤷♀️
We need T3 overnight for body repairs. So I'm not at all surprised you like taking a dose at 5am. If I wake with night anxiety a small amount of T3 calms me and has me back asleep in 20 minutes.
This is what I'm aiming for. Tomorrow morning I will be taking 1 and half grains for the first time and then 3/4 in the afternoon and 1/4 at bedtime for a few days to see how the increase in the morning feels. Then, all being well, I will move to 1 & 1/2 in the am and 1 in the pm. Finger's crossed.
That’s interesting as lately I’ve instinctively wanted to take my 1 grain NDT earlier in the morning, often 5.45ish. Means I can have and earlier breakfast at least 1 hour away. Also means I take VitD+K2 and B complex 4 hours away easily before lunch. Then second dose,3/4 grain, is easily 4 hours away from Vits but before 3pm cause after that I’m wide awake at night if I take it later. I use my phone alarm for the vits and then NDT pm dose keeps me on track!!
hi FancyPants54 im on NDT (Erfa) still adjusting doses but I take 60mg around 5 am and then top it up with 30mg dose around 1-2. At the moment that keeps me relatively stable, but I’m not sure of the optimum doseage yet. It really is a balance and for some it disrupts sleep, for others it doesn’t say. Hope you can find your optimum soon 💜
hi, I’m on 2grains of armour. I’m not strict at all as to when I take it though I do split into two doses.
I take 1g when I wake which can be any time from 8-9 am and then the second sometime between 1and 2pm. Sometimes close to food sometimes not.
I haven’t noticed that varying times etc. makes any difference to me but after reading your post and the replies, I might start paying closer attention!
One endocrinologist suggested splitting the NDT dose, as others have described, and I did this for several years. The most recent guy felt there was no point in splitting, since the T3 has a half life of 12 hours. I can't say I have noted any difference. Early morning TSH measurement seems to support this. I take it all at 5am.
A study by the USA's NIH suggests the half life can vary from six hours to a day, so it's possible splitting the dose will help even out access to T3, if you're in the 6-hour cohort. ncbi.nlm.nih.gov/pmc/articl....
It's also possible fatigue is due to any number of other things. For example, if the 54 at the end of your profile name correlates with the year of your birth (rather than the presence of 53 predecessor FancyPants with HealthUnlocked accounts), it could be an effect of age -- all the little cellular clock springs winding down as the seventh decade looms. My birth year is 1955 and I'm noticing the cellular energy tends to follow a sine wave across the day. Exercise is rejuvenating and helps with sleep, but my brain does like the self-cleaning cycle offered by a short afternoon nap.
I hope all the responses you've gotten have been some help. Getting old is interesting.
The 54 at the end of my name does not correlate with my birth year at all. I was born in 63. And my fatigue is very evidently unusual and comes in waves that change when I change doses and dose times. It's all down to thyroid I think. I've always thought it. I suddenly lost energy very fast as I hit 50. 6 months from fit, slim and very active to no energy at all and very inactive. The next few years got worse and saw the weight pile on. But I would still have days, often if I skipped a dose, when I felt perfectly normal and had my normal energy and would stride around the place unable to sit down. Then the following day it would be gone again.
I have tried taking my whole dose at once and it was delightfully convenient. But not good after a week or so. I just ran out of energy completely mid afternoon.
It doesn't help that over-treating with thyroid hormone can produce the same feeling of exhaustion that under-treating produces. I hope you can find a solution to your daily needs.
Recently, I started exercising more and I tinkered with increasing my dose from 1-1/2 grains NDT to 2 grains, because I noticed non-pitting edema. At two grains, there was no evidence of over treatment when measuring heart rate, but I was exhausted by 1 pm. BP looked better. The edema disappeared. Then I realized the calcium channel blocker I was taking for BP was creating the edema. I cut the CCB dose in half and went back to 1 grain / 1-1/2 grains on an every-other-day cycle. Much better.
Sadly, life is getting harder with the chemicals and the plastics in the rain and snow and water and food, and in our blood and tissues.
I increased from 2 & 1/4 grains to 2 & 1/2 grains in the summer just at the start of the UK heatwave. Almost immediately I puffed-up with fluid retention, terrible in my feet and lower legs and I felt that my balance was off and I could hardly drag myself around. My blood test after I'd been on the dose for the right amount of time, was low in FT3 and FT4 and I felt exhausted so I increased to 2 & 3/4 grains. No improvement. And when the heatwave stopped I still had the horribly swollen feet and lower legs. But again my blood tests were barely middling. But my BP and HR were up. That's when I decided to drop back to 2 & 1/2 grains.
I have felt a bit better and my BP and HR have improved and the swelling has reduced a bit. But I still have very little energy to cope with the day. Today I added 1/4 grain from my bedtime dose last night to this waking dose so that I took 1 & 1/2 grains on waking. And so far today I keep nodding off at my desk! That extra boost to the day didn't happen at all. I will stick with it for a few days but if this continues then I'm going to have to think about reducing further back to 2 & 1/4 grains and basically most of this year of experimenting trying to improve things will have been a waste of time.
I think dose spacing, etc, is one of those things that is very much trial and error. It is very personal, and will be related to your own biology, activity you're doing at different times, and juggling other medication and meals.
I currently take my hormone split in four doses, three during the day and one at night. I now take a mixture of NDT and T3, and I added the additional doses over time, so I'm not quite sure how many splits I had when I was on NDT-only. But I'm sure it was at least three.
My own path for getting to this point was starting off with one dose on waiting in the morning. I actually thought I was getting away with that for a long time, but I would have been very underdosed, which makes it harder to tell.
I then experimented with splitting off a dose between breakfast and lunch, which would have been about maybe four to six hours later. This seemed to be the advice at the time, to have a second dose also quite close to the start of the day. Looking at the comments you've had here it seems to be more common to have the second 8-12 hours later, which seems to make more sense. At that time I did tend to only eat twice a day... I was very disabled and hypo so my day was probably only eight hours properly awake. Probably not very comparable to others. But everyone is different with these things.
I don't think I was aware of any immediate benefit at the time, but in the years I split that way, I did juggle the size of the second dose a few times because I was feeling more tired at different parts of the day. I think that is the only way to juggle it, really. If you're more tired in the afternoon or evening, increase a later dose. If you find yourself more energetic later in the day and sluggish in the morning, then reduce later doses. I think when I took two doses I tended to take around two thirds of the dose in the morning, and a third in the afternoon. I did take half and half at some points, but I think that ended up being too much later on.
My general advice for starting out with splitting would be to take the largest dose on waking, and then start out with a small dose later in the day. Probably the smallest dose you can reasonably cut off with tablet size limitations. Take that as a starting point, stick with it for a few weeks, and then if you notice any reasons to shuffle dose sizes around then do that.
For my own third and fourth doses, they were a bit more intentional, and I was more experienced in messing with doses. Both times I split another small dose off, and added an extra timeslot later in the day. So my second dose is two hours after my main meal, mid day dinner. That only gives me enough day to have a snack later on and squeeze in my night time medication. If I was awake for long enough to fit four dose splits into my waking hours I would probably do it. But I didn't have time, so I added a night time dose. This is just whenever I wake up, so I don't know which part of the night I end up taking it, or how stable it is. I set the dose up in a little dish within reach on my bedside table with a water bottle, so I can take it without opening my eyes or even fully waking up. I have been doing this for a few years, and I now don't even think about it. I only forget to take it very rarely, maybe three times in the whole time I've done it. It's become unconscious.
These additions were a long time apart... At least six months but it may have been years. Just slowly experimenting and juggling things. For both of these additions, I felt considerably better shortly after trying them. It was roughly a similar feeling as a needed dose increase. Most interestingly, when I added the third dose, I felt a noticeable improvement in the morning both before and after I'd taken my waking dose. A good reminder that these doses don't just impact us biologically until they are used up themselves. They feed into systems in the body that continue long after those actual molecules are out of the blood stream.
I currently take those four doses. The waking dose is the largest, the second dose is also quite substantial. Depending on how flexible I am with cutting tablets over the past few years, I've often had them both the same. Then the third and fourth doses, evening and night time tend to be quite small. I have tended to make the night time dose larger than the evening dose. I've been under pressure with tablet sizes recently, and realised I don't have much of a reason for doing it that way, so I might juggle them around again and pay attention to see how it impacts me.
For me a bit of a decision is whether to save money by buying 2 grain tablets, or to take more 1 grains. A more complex choice because the 1 grains are harder to cut and give far from identical halves and quarters. My method requires A LOT of tablet cutting. Almost every tablet I take is a half or a quarter. I cut up my tablets for the next day in the evening, and I put them into little baggies. It's frustrating because there is quite a bit of variation in exactly the sizes of halves and quarters I take, when the whole goal here is to keep my blood levels consistent. I feel more comfortable with uneven pieces if I'm taking that whole tablet in one day... A whole issue. I wish we had access to a better way to take hormone and keep dosing across the day.
I think the way I ended up doing it, just because that is how things turned out for me, would be a good way to proceed. Split off and try having two doses in a day. Juggle with that, both dose sizes and timing and see what suits you. If you feel two doses has benefited you, then think about splitting off a third dose and when you can fit it into your life. For me, the third dose was when I could consciously feel a benefit. But I'm sure that is very variable for people. I felt such a benefit from adding a third dose, I was very motivated to add a fourth, and benefited from that, too. I expect I am just very sensitive to dosing, and that most people probably aren't as sensitive and don't need to split as much. I'm also still very ill after many years of trying to optimise my dose, so likely they are linked. But the only way you can find that out is by experimenting with it.
I'm already splitting my NDT dose 3 times a day SilverAvocado . I've been doing split dosing for a year. I'm currently trying to reduce that back down to twice a day if I can. But along the way I'm wondering if I also need to reduce the dose because taking 1 & 1/2 grains together this morning has more or less put me to sleep today.
Oh yes, it's a bit of a complexity, isn't it? Your dose split into three might have quite a different effect on your body than the same dose split into two.
I would consider reducing the extra dose down slowly. I saw that you've replied to someone else saying you've tried that by removing a quarter from your evening dose and adding it to your morning dose, and you found you felt sleepy that day.
I tend to think you can't conclude anything from a single day. You need to stick with the same arrangement for a few weeks to see how you'll feel. Sometimes there are unpleasant symptoms initially when you make a dose change.
Of course it is possible you'll feel worse by reducing down to two doses. Or you might feel just the same. I think it must be very hard for people who are trying to work or have other responsibilities while adjusting doses, because I think there is no alternative from accepting that you may feel worse. Which could be a few days of feeling worse, or even several weeks or months. That is unfortunately part of the risk of the process
I did that change last night. And I've been half asleep all day. But of course I will give it longer. Just disappointed because the last time I did this, moved 1/4 grain from night to morning, I felt OK.
It's very hard having problematic thyroid issues while working and looking after an elderly parent.
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