When is the best time to take T3

[12stkeepgoing]

Hi

I collected my first prescription for T3 Liothyronine 20 mg today. All the instructions on the box tell me is to take one tablet a day. I read the instructions inside and they just say to take exactly as instructed by doctor or pharmacist.

So does it matter when the tablet is taken or if it is taken with any of my other medication. I do not take any of the medication listed in the instructions not to take the Liothyronine with.

My medication at the moment:-

After breakfast at about 7am I take (epilepsy), Levetiracetam 500mg x 1 , (Arthritis), Naproxen 250mg x 1, Vit D Colecalciferol 800iu x 1 and (Arthritis), Paracetamol 500mg x 2 .

At about midday I take Omeprazole 20mg x 1 and Paracetamol 500mg x 2 .

After my evening meal about 7pm, I take Levetiracetam 500mg x 1 and Naproxen 250mg x 1 and Paracetamol 500mg x 2 .

I now take my Levothyroxine 100mg before going to sleep about 11pm.

I may wake during the night and need to take Paracetamol 500mg x 2 .

Any advice will be helpful

[SlowDragon Administrator]

Definitely don’t start with 20mcg …..far too much too soon

We always need to start SLOWLY with 5mcg once per day

(or even 2.5mcg twice a day)

What were your most recent TSH, Ft4 and Ft3 results BEFORE adding T3

How much levothyroxine are you taking

Has endocrinologist suggested you reduce dose a little…..if yes…..by how much

And essentially what are your vitamin D, folate, B12 and ferritin results

[SlowDragon Administrator]

Did you get ranges on recent test results

healthunlocked.com/thyroidu...

Was test done as recommended……early morning, ideally before 9am, only drinking water between waking and test and importantly last dose levothyroxine 24 hours before test

As you are taking PPI (Lansoprazole) it’s likely vitamin levels are poor unless you are testing and supplementing to maintain GOOD Levels

Links about how vitamin levels can be affected

gov.uk/drug-safety-update/p...

webmd.com/heartburn-gerd/ne...

pharmacytimes.com/publicati...

PPI and increased risk T2 diabetes

gut.bmj.com/content/early/2...

Iron Deficiency and PPI

medpagetoday.com/resource-c...

futurity.org/anemia-proton-...

onlinelibrary.wiley.com/doi...

sciencedirect.com/science/a...

[12stkeepgoing in reply to SlowDragon]

Thanks Slow dragon,

(I put my results in the calculator it made it easier to understand the figures)

My last test results were

TSH 2.49 mIU/L (0.38 - 5.33) 42.6%

Free T4 (fT4) 23.7 pmol/L (9.0 - 19.1) 145.5%

Free T3 (fT3) 2.97 pmol/L (2.9 - 4.9) 3.5%

T4:T3 Ratio 7.980 

The test was not done as recommended but I will do it from now on.

My other blood tests showed I was a bit anaemic and I mentioned the low highlighted on my test results to my GP the other day but my GP said they were only just below normal and nothing to worry about and the high was OK as well.

RBC 3.95 10^12/L (4 - 5.8) -2.8% LOW

HTC 0.371 1/L (0.33 - 0.46) 31.5%

MCV 93.9 fL (80.0 - 99) 73.2%

MCH 31.7 pg (27 - 34) 67.1%

MCHC 338 g/L (310 - 360) 56.0%

RDW 16.2 % (11.6 - 13.7) 219.0% HIGH

Neutrophils 3.6 10^9/L (2.0 - 7.0) 32.0%

Lymphocytes 2.1 10^9/L (1.5 - 4) 24.0%

Monocytes 0.4 10^9/L (0.2 - 1.0) 25.0%

Eosinophils 0.3 10^9/L (0.1 - 0.7) 33.3%

Basophils 0.1 10^9/L (0.0 - 0.2) 50.0%

Platelet count 245 10`9/L (150 - 410) 36.5%

Mean platelet volume 7.9

Rheumatoid Factor 10  IU/ml (0 - 14) 71.4%

LIVER FUNCTION TEST

Total Protein 73.4 g/L (60 - 85) 53.6%

Albumin 41.1 g/L (35 - 50) 40.7%

Bilirubin 6.8 umol (1 - 20) 30.5%

ALP 101 U/L (35 - 129) 70.2%

ALT 19 U/L (4 - 31) 55.6%

UE

Sodium 136.0 mmol/l (136 - 146) 0.0%

Potassium 4.1 mmol/l (3.6 - 5.0) 35.7%

Urea 3.8 mmol/l (2.5 - 7.9) 24.1%

Creatinine 68 mmol/l (60 - 120) 13.3%

Estimated GFR >60

Thanks

[SlowDragon Administrator in reply to 12stkeepgoing]

So how long before test was last dose of Levothyroxine

What time of day was test done

Which brand are you taking

How much are you taking

No vitamin D, folate, B12 or ferritin results

[DippyDame]

Whatever time it suits you best!

I need high dose T3 and take it in a single dose at bedtime

But....starting with 20mcg is too high and your body may rebel! Increase low and slow.

Best to change only one thing at a time..

T3 will lower both TSH and FT4 so probably not necessary to reduce levo initially

Some people may find they need less than 20mcg so monitor for symptom changes....I use a diary to record doses, symptom changes etc.

I would start with 5mcg for 2 weeks ( You may find it easier to split the 5mcg initially) then add the next 5mcg....repeat every 2 weeks until you are taking 20mcg.

After 6 weeks on 20mcg test again and alter dose(s) if necessary

Testing should be done 24hours after last T4 dose and 12 hours after T3 dose.

Good luck

[12stkeepgoing in reply to DippyDame]

Thanks

[12stkeepgoing in reply to DippyDame]

Hello

Thanks. just an update.

I took the Liothyronine 20mcg tablet last night before sleep with water and put my 100mcg Levothyroxine under my tongue. I did consider the advice about starting on a lower dose and will go to the doctor if I get any bad side effects.

However it has taken so long to get any treatment for how bad I have felt for so many years, I wont give the doctor any opportunity to question further the validity of me having this medication. The GP I saw the other day, said that another GP had already wrote the prescription days before and would be ready to collect. They continued to say that of course the practice would prescribe it, because the consultant had advised it, but there is no proof that it works, it cost a lot of money and may not do anything to help me.

I did think about cutting the pill and taking it in two doses but it is just too small for me. The instructions said the pill could be dissolved in water and a lower dose measured into a syringe. However the instructions also say to throw the remaining pill liquid away. This would prevent me taking a second dose from that pill and my prescription would not last 28 days.

[Forestgarden in reply to 12stkeepgoing]

How do you feel today after your 20mcg lio? How did you sleep last night? Any noticeable changes? You can get very cheap pill cutters which are easy to use to split your 20mcg tablets into 4.

[12stkeepgoing in reply to Forestgarden]

I feel OK and slept well. I didn't even get up during the night which I usually do at least once. I may of slept so well because I did a lot more physical work yesterday and even managed to walk to and from a friends house on my own about 200 yards away. Maybe it was because the sun was shining and warm at last.

[Forestgarden in reply to 12stkeepgoing]

If you get side effects from too high a starting dose, personally I would not point this out to the gp who could use it as an excuse to stop prescribing. Better to do your own thing, start with a lower dose to let your body adjust until you get up to the 20mcg daily

[12stkeepgoing in reply to Forestgarden]

Thanks

[DippyDame in reply to 12stkeepgoing]

.... but there is no proof that it works, it cost a lot of money and may not do anything to help me.

Well....that's more of a threat than a promise!!!

If you need T3 and you get the correct dose for you as an individual, then of course it works. It saved my life.

The problem is that medics do not understand T3 for some unfathomable reason....it is no more dangerous than any other medication if it is used correctly.

Don't be too surprised if after a few days with T3 you feel off colour...the body takes time to adjust. But it may help to split your dose for a week or two to allow the hormone to slowly settle.

I've never tried to dissolve T3 tablets....those instructions to discard remaining liquid are wasteful and pointless. Just swallow the dose you require with a glass of water and forget all that faffing about!

No need to discuss splitting your dose with the GP....they are pretty clueless about thyroid conditions at the best of times.

I use the above pill cutter cheap and effective from Amazon, Boots ...

I find dosing at night is easier, it keeps the hormone well away from food and drinks....I need 125mcg T3 taken in a single dose at bedtime. It's a huge dose which would be dangerous if I didn't have a form of Thyroid Hormone Resistance.....but just mentioning it to show it's safe to take at night!

Who suggested you take levo sublingually? As I understand it the T4 molecules are too large for this to be effective, so best/ easiest if just swallowed with water.

There is a lot of nonsense and scaremongering quoted about T3

Use the lowest effective dose, not the largest dose you can tolerate

Monitor for any symptoms of overmedication.

e.g

....fast heart rate ( normal resting heart rate is 60 - 100bpm)

...hand tremor

...heat intolerance

...anxiety

...disturbed sleep

There is no quick fix, but there is a fix!

So...relax, take things slowly, be very patient and don't let the naysayers upset you.

Pill cutter

[12stkeepgoing in reply to DippyDame]

Thankyou,

It is so hard to know what it right when the doctors are so distracted with clock watching, cost and one thing at a time visits.

In the past I used to leave the doctors feeling like a hypochondriac, fraud or at best just soft. This even though I know I'm not, its just thyroid symptoms can be so hidden and ignored. Neurological symptoms are not treated much better if 'stable'.

One recent visit to my GP I took a list, only six words and the first thing the GP said was "I don't think we will get through all those in one visit. Actually the first question/word note answered the other five, so there was only one question. Not the best way to address your patient and give reassurance.

Yes, I will buy a pill cutter just in case.

[Teresabessong1]

Hey u need to take Levothyroxine in the morning before food or caffeine hope this helps

[helvella Administrator in reply to Teresabessong1]

It is perfectly reasonable to take levothyroxine at bed-time as the original poster says they do.

helvella - Bed-time dosing of levothyroxine

Discussion about taking levothyroxine at bed-time.

helvella.blogspot.com/p/hel...

[12stkeepgoing in reply to Teresabessong1]

Thanks,

I used to take all my medication together after breakfast and my second doses after my evening meal. Since joining this group, I first started taking the Levothyroxine in the morning on waking about 40-60 mins before breakfast then the rest of my medication after breakfast, and my omeprazole at midday. I have to take my epilepsy medication twice a day 12 hours apart so it makes things hard. I have now changed taking my Levothyroxine to bedtime and can keep food and other medication away easier late at night.

[SlowDragon Administrator in reply to 12stkeepgoing]

I have now changed taking my Levothyroxine to bedtime

Really you should retest thyroid levels 6-8 weeks after changing to taking correctly BEFORE even starting on T3

And get vitamin levels tested

[Otto11]

Hi I don’t know if this helps but I started in T3 in December. I was told to take 20mgs split into 2 doses 8 hours apart. With the help from this group I started slowly on 2.5 mcg twice a day then slowly increased. I just arrived at 10 mcg twice a day dose 2 weeks ago so 2 months after starting. I’m slowly improving & the Endocrine nurse was fine with me taking it slowly with just small increases at first. I did mix mine with water but saved the remainder in the fridge for later that day. I take one dose around 8am & the second at 3pm. Like you I take my Thyroxine at night about 11pm. If you have an Endocrine Nurse then it would be good to contact them for their advice. Mine has been amazing even though I’ve never met her.

[12stkeepgoing]

Thanks, I will take note of what you say. I have never had a endocrine nurse or consultant.

I have always thought (30+ years) my physical symptoms were neurological and arthritis with just a bit of tiredness due to low thyroid.

If I don't get sorted with T3 I will ask for more answers from my GP.

[Hashiboy]

Like SlowDragon said I'd go low and slow. Starting on 20mcg in one go would probably give you palpitations, shakes and a bit of a high. Maybe cut it in half or even check if you can get some 5mcg prescribed to space over the day to start with. Good luck.

[Gillybean1]

Hello 12stkeeping, please please listen to what others here are saying to you on here and go LOW and SLOW to start, it would be a shame if you have waited this long for T3 to run into problems as others are indicating here by going too fast. I speak from experience.

And wish you every best wish, Kind regards G