T4 and T3 split dosing

[Lavender-Blue]

For those who are on T4 / T3 combination therapy, please can you share your regime and also what were your symptoms before and after splitting ?Thank you in advance.

[TiggerMe Ambassador]

I take my full dose of T3 & 4 sometime between 3-6am (bladder dependent) and find this works better than splitting my T3 into smaller doses as I would always hit a slump between doses

[Incoguto]

I think this would be different dose depending, if someone takes a rather big dose, sometimes they need to split, when they take maybe only 5 to 15 t3 with their t4 dose, they don't split. Smaller t3 doses result in smaller peaks, not everything will get into cells that way. I used to take a full dose of 150 t4 and 38 t3 at once, now splitting, but the jury is still out on what works. One full dose used to work for me well until I couldn't tolerate it anymore. Smaller doses at once results in being hypo for parts of the day, with bad symptoms. So splitting definitely helps with these.

[FallingInReverse]

I take 75 Levo, 10 mcg T3.

Originally 5 upon waking, and 5 at bedtime.

Saw in my symptom journal at the time that I was needing a nap around 2 pm-ish.

I split my morning dose to 2.5 at waking (around 7 am) and then 2.5 around noon.

Voila! No more 2 pm naps!

At the time I was still early days on Levo, and absolutely under-replaced overall. I do wonder now after my Levo/T4 is coming up, whether my baseline will keep me above water at the 2 pm time. But I'm not messing with it at this point.

[Forestgarden in reply to FallingInReverse]

I take 100mcg levo plus 5mcg lio at 7.30am, then 5mcg lio later. I too have that afternoon slump and need to nap and have been struggling with the timing of my afternoon t3 dose, not least trying to take it on an empty stomach. I've been waiting until 3pm-ish, but think I'll try doing what you do and take it midday.

[FallingInReverse in reply to Forestgarden]

This article helped me, gave me the idea that T3 peaks 2 hours after dosing. I don’t do all the other stuff it talks about, but the peak info was helpful to combat my once-predictable 2-3 pm involuntary nap.

thyroidpatients.ca/2020/07/...

[Forestgarden in reply to FallingInReverse]

I read this quite a while ago I think, but will read again. Took 5mcg at midday today so will see if I can get through this afternoon without a nap !

[Lavender-Blue]

I have been asked to take sll T4 at bedtime and T3 split throughout the day. However, tried last night and woke feeling hypo.

I have been debating all day what to do; upon waking I took first dose of T3, however still felt hypo, so at 11.30am took 50mcg T4.

I feel that maybe 50 T4 with 5 T3 first thing, saving the same amount for late evening if possible and take remaining 10 T3 during the day, either all together or split into 2 x 5mcg doses.

Thank you for sharing, greatly appreciated! 😊

[McPammy]

I take my meds as follows :

T3 5mcg 07.30am

T4 34mcg 12.00 noon

T3 5mcg 3pm

T4 34 mcg 5pm.

I take Thybon Henning t3. And I take Mercury Pharma 50mcg strength liquid levothyroxine.

I’ve always split the t3 8 hrs apart. I’ve felt brilliant since starting it.

I use to take levo in one dose but 2hrs after taking it I use to feel like a mad rush that could last hours. Since splitting the dose I have no symptoms and feel much better. I feel too much in one go is no good for myself.

[Lavender-Blue in reply to McPammy]

Thank you McPammy for sharing. X

[Gosierunn in reply to McPammy]

Sorry to piggy back on to this   McPammy - can I ask how you manage food intake around that protocol? I’m about to start T3 medication - do you have to take distanced from eating? I currently take 50mcg of T4 at 8am, and have been given a protocol by my dr for taking but just interested in this regime and very encouraged that you have felt brilliant since starting. How long have you been on the combination therapy? And how has your QoL improved? (Don’t feel you need to reply if too invasive!)

[McPammy in reply to Gosierunn]

I take liquid levothyroxine and as it absorbs 100% or much better than tablets I dint need to avoid food but I do try not to eat with a meal or at least 30 mins either side just incase. T3 I take in between meal times but I don’t think it’s as tricky as levo.

I’ve been on combination meditations now for over 4 years. Prior on levothyroxine alone I had many symptoms but didn’t realise why. I ended up being unable to hardly walk I got very bad. I lost my job and had zero help from the NHS. I went private to get diagnosed within 2 consultations and out on liquid levothyroxine and T3 medication. Within a few days I could stand up straight and walk. The recovery increased day by day. I went out side and actually walked. I felt great. My T3 was only 8% prior. I’m a poor converter of T4 to T3 and also got the DIO2 gene test which was positive. Thank god for this forum and people who helped me the I was house bound. I lost all the 4st I piled on without dieting. My metabolic rate was now optimal. I believe I’m symptom free as all my levels and TSH are in range and optimal. My vitamins needed addressing too. B12 now I get injections off my gp. And I have ferris fumerate for low ferritin also. Vit D and folate are naturally good.

[Gosierunn in reply to McPammy]

Thank yon for sharing. I’m so glad you are back on track and what a journey - I’m sorry it got so bad and that you had little support. Do you have Hashimoto’s?

[McPammy in reply to Gosierunn]

Yes hashimoto’s with very poor conversion from t4 to t3.

[Clara9 in reply to McPammy]

How did your levels change once you started splitting? Can you tell me your before and after tsh ft3 fått please?

[McPammy in reply to Clara9]

When I was taking just t4 levothyroxine the level was 14.00 ( range 7.86-14.41).

Then I needed t3 also as my t3 was only 3.9(range 3.7- 6.0) added as combination treatment

I’ve always spilt my T3 5mcg twice a day. Now ‘with taking’ T3 2hrs before my 9am blood draw it’s 5.6 (3.7 - 6.0). I never go over range. That’s my aim to mirror a healthy persons thyroid levels

My T4 now I’m splitting it also is 9.6 (7.86 - 14.41). I don’t take levo T4 before my blood draw

My TSH is 1.09 (0.35-5.50).

Those figures I received yesterday as my gp did my bloods on Tuesday this week. I get my bloods checked by my gp every 3 months without fail.

I don’t change my medications timings for a blood test

I don’t want a suppressed TSH.

[Clara9 in reply to McPammy]

Thank you! What time were tests done? How long since last dose T4?

[McPammy in reply to Clara9]

9am. Last dose of T4 4.30pm previous day.

[Clara9 in reply to McPammy]

Thanks!