Benefits of split dosing T4

[Jefner]

I hearken back to my post a few months ago

healthunlocked.com/thyroidu...

where I was struggling (and still am) to find a solution to the severe waking anxiety I have had to tolerate for years now.

As I feel my adrenals are still playing a big part as I cannot deal with the slightest bit of stress, since my last test back in July last year I have trying different split dosage times of my 10mcg T3 but still taking my 125mcg T4 around 9am, go back to sleep until lunchtime, then usually have my first T3 dose mid afternoon and second around 7pm. Then I tried first dose at around 1pm when I wake up with second dose around 7pm

As a trial I went back to take my first dose of T3 with my T4 around 9am this morning and when I got up around lunchtime I have been feeling like hell all day with severe anxiety so I still think I need to take my first dose later in the day away from my morning cortisol to help protect what feels like my wrecked adrenals as T3 can stimulate more cortisol production and I really don't need that.

I read when cortisol levels are high, it signals the thyroid gland to stop producing as much thyroid hormone. Cortisol also restricts the conversion of the thyroid hormone T4 to the active thyroid hormone T3 elevating reverse T3 levels rather than converting which might explain my high rt3 results back when my cortisol levels were through the roof.

I have also read about sufferers split dosing their T4 and wondered what the benefits of doing that are as it's a storage hormone?

Have had a very stressful two weeks with damn pharmacies, my trying to source my usual brands and trying to get back on track from the Aristo brand I gave a chance about a month ago but found my hypo symptoms coming back.

I am now thinking of trialing taking my full dose of T4 with my first split dose of T3 around 3pm. Was also thinking of split dosing my T4 but as I mentioned, I have no idea of the benefits of that if someone could explain please? Could also take second split dose of both at around 7-9pm before my dinner?

Also what is the ideal timespan between each dose ie. 4,6.8 hrs?

I haven't tested since last July and have a kit ready to do so wondering whether to test before I change things again or change now and test in a few weeks? I also need to seriously look at introducing a small 5mcg T3 increase as most have said on here for a few years that my levels are far too low in the range, which could be causing the severe anxiety although I have had a long history of it anyway before I was hit with thyroid problems, but have had so much other stuff to work on having Hashi's, HRT and stuff; you just can't change more than one thing at a time or you don't know what is and isn't working.

[McPammy]

I find splitting my levo dose suits me better. For some reason I couldn’t tolerate a full dose anymore after a decade of taking a morning full dose. I split my doses as follows:

07.30am - T3 5mcg Thybon

11.30am - Levo 35mcg liquid

3pm - T3 5mcg Thybon

4.30pm - Levo 35mcg liquid

Our bodies don’t make these hormones in one batch a day So I thought splitting might ease things I feel my body prefers splitting rather than big dumps

I find this regime for myself works well. My TSH is normally around 1.00 in range. My T3 is normally 80% through the range. And my T4 is around 40% through the range.

I don’t have any symptoms. I get my bloods checked every 3 months by my gp without fail. My cholesterol is ok around 5. My cortisol 9am is good around 300. I get b12 injections and I take ferris fumerate for low ferritin. My vitamin D is never below 100 naturally. And my folate is good too ( can’t remember the figure just now). I’ve worked hard to get my levels best I can for me since I introduced T3 and realised my vitamins are equally important to get optimal. I’m a creature of habit and keep to this regimen. I feel my body really doesn’t like change. As long as I get my regular brand of T3 and my usual T4 liquid I’m good. If the brands change I will struggle a bit until my body gets use to that change. Most importantly I feel well, energised and healthy.

[Andie222 in reply to McPammy]

Hello McPammy. I'm interested to know where you fit vitamins and in particular ferrous fumarate into this regime bearing mind the recommended 4 hour gap.

[McPammy in reply to Andie222]

My ferris fumerate 210mcg I take with my evening meal around 6.30-7pm. I don’t need to leave 4hrs as I take liquid T4 which absorbs much better than tablets and more quickly. I don’t take ferris fumerate every day. I find it’s too much for me. I take maybe 2/3 times a week. I sometimes leave it off for a week too. Otherwise it’s just too much. I do get me bloods checked every 3 months last time it was 90 so I’m ok not to take every day I feel. I do feel a surge in my body when I’m on it. Like my t3 is proper working.

B12 I get injections every 3 months

I dont take any other medication or vitamins

[Andie222 in reply to McPammy]

Ah that makes sense. I considered splitting levo but decided I couldn't fit everything into the day. 🙂

[McPammy in reply to Andie222]

It can be difficult. Try requesting liquid levothyroxine. It’s so much better than tablets. But it is expensive.

[Hashihouseman]

T4 is not a storage hormone, it plays a minute by minute active role in feed back and feed forward loops and supply for conversion to T3. Only half of total T4 is 'stored' in slow exchange compartments (organs and tissues) the rest is in fast exchange tissues and plasma which equilibrates demand and supply within hours and days not weeks and months as the notion of 'storage' infers. In my experience and logically when T4 is close to being optimal small changes have noticeably significant effects unlike it taking along time to stabilise changes to gross over or under supply over long periods. Stable and physiological levels of ft4 are essential for thyroid metabolism to sustain a dynamic equilibrium that the healthy thyroid gland and all the feedback loops facilitate

Without seeing your blood test levels for free t4/3 and tsh my first thought that you are over medicated cant be substantiated but.... these hormones are super powerful and it seems unlikely that your adrenals are having more effect on your thyroid metabolism than an excessive amount of either t3 or t4 or both? Excess T4 will decrease the rate of conversion to T3 and excess T3 will increase reverse T3. Excess T4 can lead to a confusion of symptoms that can appear in some ways hyper and some ways hypo....

whatever your replacement regimen you may be better placed to consider whatever else may be affecting your wellbeing if you target a blood level of thyroid levels that are categorically normal (euthyroid ). This would probably be around TSH 1.25 FT3 4.4 FT4 15 by whatever combination of Levothyroxine and Liothyronine that achieved it. Then perhaps you could rule out thyroid pathology and consider adrenals etc.

Another guide to dosing replacement is to consider the healthy thyroid gland produces the equivalent of c 110mcg t4 and 7-10 mcg t3 and the t4 output in particular is pulsatile and more or less even hour by hour - the healthy thyroid gland does not produce all our t4 at 6am or whenever a doctor prescribes it and so split dosing of thyroid hormone replacements is potentially physiological unlike prescription dosing! I split my t4 and t3 into three doses sleeping waking and midday, it works for me and gives the least side effects and the best blood levels.