change of regime

[Sat2]

I’ve been taking my levothyroxine at night , around 22:00 for around 3 years since my diagnosis with infectious SAT. I’ve had up and downs as we all have but I’ve always suffered mid afternoon fatigue that I’d almost come to accept as the new norm. I took my meds at night simply because I like to eat as soon as I get up and waiting up to an hour after taking my levo was never going to happen. However I found an article about plasma concentrations after taking levothyroxine and it suggests that concentrations are at their lowest at around 18 hours after consumption, about 15:00-16:00 just when I feel at my worst. So I considered an experiment, taking half my dose at the normal time 22:00 and the other half of the dose in the early morning and thus have two plasma curves overlapping each other. This should I thought help flatten out the peaks and troughs and give a flatter curve through the day. Have to say not happy about waking at 05:00 to take my meds. But after about a week I am not feeling fatigued in the afternoon and I am carrying on being active into the evening and writing this at 23:00 rather than being completely done by 18:00. I’m feeling the best I’ve been since I started this wretched illness.

Coincidence or not, not sure, has anybody else tried twice daily dosing of levothyroxine, any other comments and thoughts please.

ncbi.nlm.nih.gov/books/NBK5...

[TiggerMe Ambassador]

Some people that struggle to take T4 prefer to split the dose and it might give slightly improved uptake but looking back at your last post you really aren't a great converter and your folate, B12 and Vit D were all very low, have you sorted out your supplements since then?

03/04/2024 MMH. TSH 2.47 (0.27-4.2), T3 4.0 (3.1-6.8), T4 21.1 (12.0-22.0)

TSH 2.47 mIU/L (0.47 - 4.2) 53.6%

Free T4 (fT4) 21.1 pmol/L (12 - 22) 91.0%

Free T3 (fT3) 4 pmol/L (3.1 - 6.8) 24.3%

T4:T3 Ratio 5.275 

Ideally you need a referral to Endo to trial some T3

[Sat2 in reply to TiggerMe]

They have improved, as of 22/05/24

Folate 10.1, B12 136, Vit D 73

As of 11/07/2024

TSH 0.65 (0.27 - 4.2), T3 4.7 (3.1 - 6.8), T4 21.8 (12.0 - 22.0)

T4:T3 = 4.64

I appreciate not a great converter, but getting an increase from 75mcg to 100mcg from my GP was like getting blood out of a stone, getting an Endo referral will be a non starter and I feel they're not really any better in any case.

My main point was that I have had a huge improvement in how I feel to the point of feeling almost normal by splitting my Levo across two doses and I was wondering if others have had the same results.

[TiggerMe Ambassador in reply to Sat2]

So your B12 is reasonable now (assuming this is an active level rather than total?) but both your folate and Vit D could be doubled, certainly seems to have made a slight improvement with your conversion.

grassrootshealth.net/projec...

[Sat2 in reply to TiggerMe]

Yes, B12 is active. Thank you, I will look at increasing my folate and B12.

[SlowDragon Administrator]

06/03/2024 Dose increased to 100mcg

03/04/2024 MMH. TSH 2.47 (0.27-4.2), T3 4.0 (3.1-6.8), T4 21.1 (12.0-22.0)

on results above

Did you change timing of last dose Levo to 24 hours before test

Get retested after 6-8 weeks on split dose regimen…..including vitamin levels as well

[Sat2 in reply to SlowDragon]

Yes, I always follow the regime on here to ensure it's a 24 hour pause before testing.

I will get retested and report back on here.

[Pfhh]

I had a medication review with my local pharmacist a few years ago and he suggested I split my medication to 100mcg morning and 50 mcg before bed. Said I would get more from my medication than all in the morning. So always taken it that way and don’t get any dips mid afternoon.

[MyOrangeDog]

yes I do! I also got those big drops in energy but the reason I split mine ( into 3 doses over 24 hours) is I’m so sensitive to it and would get palpitations which were really frightening. A side effect of doing this is I don’t get those lows in the afternoon 👍

[Sat2 in reply to MyOrangeDog]

I did consider three doses but decided I couldn’t fit them in and leave adequate time either side of the dose without food to avoid affecting absorption. How have you managed to do this or are you not to worried about it.

[MyOrangeDog in reply to Sat2]

Well it takes some commitment because I take vitamins too which need to be four hours away from the Levo but it can be done. There have been occasions where food has been too near taking my meds .. it’s not regular so I try not to worry ( I worry about everything usually!).

👍