Taking Levothyroxine at night

[VSHchocolate]

I have had no thyroid since 2000 due to thyroid cancer. I was taking 100mcg Levothyroxine and 10mcg of Liothyronine. ( prescribed by NHS Endo) I had started feeling quite anxious / jittery and wondered if it was the Liothyronine. So I stopped taking it and started taking 125mcg Levothyroxine x5 days and 150mcg x 2 days , which was the dose I had previously been taking when I felt quite well. ( I am pretty convinced I started feeling unwell due to taking Teva brand, I am now prescribed Eltroxin)

Prior to stopping T3 my results were :

Free T3 5.6 (3.1-6.8)

Free T4 17.3 ( 12-22)

TSH 0.049 (0.27- 4.2)

Folate 13.3 (>7)

B12 >150 (>37.5)

Vitamin D 177 (50-250)

So not over range except TSH which I gather is to be expected on T3.

I have stopped feeling jittery and anxious, my resting heart rate has only dropped by 2 bpm.

I have always taken my medication in the mornings but having read that absorption can be better at night, I switched to taking it before bed. I have found it more convenient in terms of eating / drinking in the morning, but after a few days my sleep has become really bad. I have never slept particularly well but the last few nights have been horrendous, taking ages to get to sleep, waking up more frequently than usual then finding it difficult to get back to sleep. I have tried OTC sleep aids from the pharmacy and some melatonin I bought in USA and it has made little difference.

Has anyone else experienced this? Does taking Levothyroxine at night not suit some people ?

Many thanks in advance. 😊

[TiggerMe Ambassador]

Some are more sensitive to timings than others, also the speed of uptake, some people might get a boost a few hours after taking which could be disruptive, it could be that splitting the dose gives a smoother ride?

Your levels looked pretty good on the combo have you not tested since dropping T3?

Do you have previous results when you felt well?

[VSHchocolate in reply to TiggerMe]

Hi

I have only been back on T4 only 2 weeks, I have the Medichecks test ready to do in a few weeks.

I don’t think feeling unwell is to do with my levels. I am pretty sure it relates to me taking Teva. I felt well on T4 only for 22 years. In the early days I was better on certain brands than others and it was easier to get Drs to work round it then.

I only have TSH results from the NHS for my earlier bloods, my TSH target is the bottom of the range due to the type of cancer I had. I am still on annual checks after 25 years. I also see an endocrinologist on the NHS.

Splitting the dose would mean I don’t have the benefit of eating when I like in the mornings ! Which is why I am thinking I will just go back to taking it all in the morning.

[TiggerMe Ambassador in reply to VSHchocolate]

I take it when I get up for a wee often 4-6am

[DoeStewart in reply to TiggerMe]

Me too, I find it the easiest way..

[VSHchocolate in reply to TiggerMe]

I think that’s what I need to do !

[TiggerMe Ambassador in reply to VSHchocolate]

I'd recommend having it ready in a little pot so you don't mistakenly take extra if you are having a broken nights sleep 🤗it saves puzzling over have I haven't I... 😵‍💫

[pennyannie]

Hello VSHchocolate and welcome to the forum :

Without a thyroid the TSH is of little importance and we should be dosed and monitored on the Free T3 and Free T4 results and ranges -

So these results are from taking 100 mcg T4 + 10 mcg T3 - and in the range -

but with the introduction of T3 you have started experiencing symptoms of insomnia -

and not feeling as well as when on T4 only at 125/150 mcg. - is that correct -

So do you have some bench mark readings of your T3 and T4 when on T4 monotherapy and feeling as though you were doing ok -

what lingering symptoms were you experiencing when on T4 only that decided you to trial a T3 / T4 combo - and have these symptoms been relieved ?

Maybe switching to taking the T3/T4 at bedtime caused this uneasiness ?

Did you start at 10mcg T3 - maybe the T3 needs to be introduced at 5mcg x 2 am & pm a day -

or maybe 10mcg T3 + 100mcg - is just a little too powerful for you to take on a daily basis - and you just need a small adjustment in either the T3 or T4 dose level ?

Do you have a ferritin reading there please ?

Has switching to Eltroxin made any difference ?

I too haven't a thyroid - ( RAI thyroid ablation for Graves 2005 ) and I felt turbo charged when I added in T3 and over medicated myself -

and so I then decided to try Natural Desiccated Thyroid which seems much ' softer ' on my body and suits me better -

I take my NDT in the middle of the night - around 2/3 am at a toilet break and wake up around 2/3 hours later - not ideal for some maybe - but this works for me - in bed by 10 pm - and dovetailing into the circadian rhythm of the body seems to be where I feel best - and can have that cup of tea or coffee when I wake up !!

[VSHchocolate in reply to pennyannie]

Many thanks for your reply . I started at 20 mcg T3 and 75mcg T4 I reduced to 10mcg T3 and 100mcg T4. I have stopped taking T3 as I was feeling jittery and anxious. This has stopped since I have gone back onto T4 only.

I think switching to Eltroxin has made a difference. I felt well on T4 only for 22 years it was only when I started taking Teva that I started to feel unwell. I am sensitive to other food additives such as MSG.

I recently started taking my T4 at night and after about a week my sleep has become very disrupted and my query was is this something that happens to some people.

I have previously tried NDT but didn’t feel markedly better taking it so didn’t feel it was worth the expense.

My TSH is important due to my cancer. It needs to be at the bottom of the range. It had to be suppressed to below the range for many years.

My Ferritin is 157 ( 30-332)

[pennyannie in reply to VSHchocolate]

Ok then - good ferritin - maybe a little high - if supplementing - maybe ease off a little :

It would be interesting to see a blood test when just taking T4 monotherapy and where you felt at your best - as this is where you likely need to try and get your T3 and T4 levels back to.

Some people can get by on T4 only :

Whilst others need to add back in that little dose of T3 their thyroid once supported than with - in order to restore their health and well being as best as they can.

[VSHchocolate in reply to pennyannie]

I don’t take any iron supplements so I guess that Ferritin level is just down to diet etc ?

[pennyannie in reply to VSHchocolate]

Could be inflammation - do you have a reading there for CRP ?

Otherwise - I think - due to a very good level of metabolism and absorption :

From diet I would imagine you a big meat eater ?

[VSHchocolate in reply to pennyannie]

My CRP is 1.39 ( <3) I have osteoarthritis so would expect some inflammation. I eat very little red meat. Not even once a week.

[pennyannie in reply to VSHchocolate]

Oh ! - well - I'm stumped - it's likely genetics - though maybe going by your user name I'm gonna eat more dark chocolate then !!

[helvella]

You might already have put your finger on the issue:

absorption can be better at night

Therefore switching to bed-time dosing can have the effect of incrementing your dose.

I suspect that for some people the change in absorption is very minor. But for others, it might be much more significant.

From that, I suggest considering reducing your dose. Maybe 100 and see how it goes? I'm not usually keen on skipping doses, but possibly even not taking any for a day. Or two days at 50. To help drop what currently might be too high a level.

We are all different and what works for one, just might not work for someone else. Including any need for adjustment to dose - whether needed at all, and by how much.

helvella - Bed-time dosing of levothyroxine

Discussion about taking levothyroxine at bed-time. Several linked references to relevant papers.

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

[SlowDragon Administrator]

if you dropped 10mcg T3 in one go that’s likely to be affecting you for a few weeks

That’s a large reduction in one go

Move taking Levo to 5-6am and see how things settle

[VSHchocolate in reply to SlowDragon]

I think that is what I will do. Unfortunately I am prescribed T3 capsules so it’s very hard to split them accurately. Thank you for your advice 😊

[SlowDragon Administrator in reply to VSHchocolate]

Many people don’t get on with capsules

[VSHchocolate in reply to SlowDragon]

It’s all about the cost isn’t it ! I was dispensed Morningside tablets once the rest are Roma capsules. 😌