Hi please can anyone advise if its OK to take heme iron within 2 hours of taking liothyronine? I've just started lio and take heme due to Anaemia otherwise (I also have P.A) and the only time of day my 2nd lio dose can be taken due to other supplements etc, is 2ish hours before it.
Will that affect absorption of either / each at all please? Thankyou
The problem we have is that there has been relatively little work done on interactions between liothyronine and medicines, supplements, food and drink.
There has been a tendency to assume the liothyronine behaves like levothyroxine. Which seems both understandable and entirely wrong-headed - at the same time!
The issues with non-heme iron and levothyroxine were due to direct binding between the iron and the levothyroxine. Heme already has the iron well bound so seems to protect against that specific issue.
If you were adding heme to an established regime of taking liothyronine, it might have made sense to try it and see what happens. Keeping a close eye on things.
Thanks very much for your reply. It's more that the heme is well established rather than the lio (I'm just over a week over on lio, 1st dose is with levo in a.m). So on that basis should I be more cautious?
I also take folate and probiotics at the same time as heme, and quercetin a couple of hours before lio. SlowDragon did say these should be fine apart from not being sure of heme, so just checking here for completeness if that's ok please? Thanks again
It's difficult to come up with any better ideas, I'm afraid.
Just be aware. And keep your fingers well and truly crossed. 
Thankyou, yes I'm just not sure I should risk it. Do you mean you're also unsure about the other supps I mentioned too? Maybe I should take heme at lunchtime with my quercetin and move lio to 5pm rather than 4pm so that both lio and levo are 4 hours away from it all?
The only one I do take an hour after a.m dose is Vit D3/K2 as there's literally no other option but that hasn't affected my levo absorption thankfully
There comes a point at which trying it is the only sensible way forward.
If all works well, great. If not, rethink a bit.
I think the balance of probability is that it will be fine.
Thankyou it's just I've waited so long to get lio after 2 years on levo a d experimenting with that, and been so ill for decades prior so I don't feel i can keep experimenting with cofactors really. As the lio will take a while to get me optimal on its own 
My P.a diagnosis was only last year and I've had such bad neurological issues, and until thyroid is optimal it won't reverse as quickly so I do feel my time is quite limited. I really appreciate what you're saying though thankyou so much x
If you want to eliminate one timing issue - use the Better You Vit D-K2MK7 spray It bypasses gut. I use it very shortly after my NDT. I, too, take iron (Three Arrows)so I think I need more than 24hrs in a day to time out all of the supplements! PS Three arrows is hemme, but has an easy work-around.
Hi thanks very much, I also take 3 Arrows! I know what you mean about needing more than 24 hours!
I've changed to having heme and folate at lunch, so 4 hours after levo/lio and 4 hours before my 2nd lio dose. Still working up from 2.5mcg each to 5 but going well so far so hopefully this will stay positive!
I can't use D/K spray unfortunately, it has to be gel cap in the gut as a cofactor to my B12 injections, but thankyou anyway 😊
Reasons it’s “probably” an issue: heme and lio are both absorbed in the same place in your small intestine.
Reasons it’s “probably” worth a try:
But, their absorption pathways are different . Iron has specific receptors and transporters, whereas Lio has no receptors or transporters - it just absorbs through the intestine wall.
Me personally - I don’t do anything for a hour after Levo or Lio, and 2-4 hours before Levo/Lio if only for consistency. But if you are squeezing something in I can see why you’d try to compress, so I’d say whatever you do, be consistent . IMO.
Thanks so much for explaining. My absorption isn't great due to Pernicious Anaemia and hashi/hypo anyway so abit concerned really. Yes hear you on being consistent!
I also take probiotics, quercetin and folate, are these an issue at all do you know please?
I'm now wondering if I should take heme at lunchtime (rather than dinner) with my quercetin and move lio to 5pm rather than 4pm so that both lio and levo are 4 hours away from it all?
The only one I do take an hour after a.m dose is Vit D3/K2 as there's literally no other option but that hasn't affected my levo absorption thankfully. I also have magnesium glycinate last thing at night so restricts things abit more. Wanted to start mag malate at lunchtime too but if I take heme then, they'll interact! Such a pain isn't it? Thanks again for your help I really appreciate it!
If u can reply with your schedule
A line for the time and thing taken
Easier for me to weigh in : )
Ah thanks,.okay here goes. The times are approximate but morning meds always 4 hours before lunchtime.
8 - 9am Lio / Levo
9 - 10qm breakfast with D3/K2
1 - 2pm lunch with 2 types probiotics (histaminX and Saccharomyces boullardii)
400mg quercetin.
*Possibly take heme here? Or magnesium malate if not
5 to 6pm.Lio
7 to 8pm dinner with same 2 probiotics, 5mg folate (due to b12 injections)
*was taking heme here, or take with lunch instead?
Hope this makes sense and thankyou so much!
I take T3 as 5mcg 4 x per day
So my typical regime is
Alarm 6.15am take half dose levothyroxine and 5mcg T3
Go back to sleep
Breakfast 8.30-9am
Vitamin D mouth spray and B complex after breakfast
Plus zinc or selenium just once a week
10.30-11.30 ish 2nd 5mcg dose T3
5pm roughly 3rd 5mcg dose T3
7pm magnesium
11pm half Levo and last 5mcg T3
I don’t have to fit iron in …but if I did ….it would be 2pm approx
Thanks very much for this it's so helpful. I've changed to having heme and folate at lunch, which is about 1 or 2pm so 4 hours after levo/lio and 4 hours before my 2nd lio dose. Still working up from 2.5mcg each to 5 but going well so far so hopefully this will stay positive! Thanks again for all your help in both of my recent posts, it's much appreciated 😊
Thoughts
- do wait an hour after your morning Levo. There’s confirmed biology behind how efficient Levo absorbs on an empty stomach … a solid 1 hour is really best for absorbing it all and consistency. Some would say 1-2 hours. But if you must you could prob do 45 min if u had to but it’s close.
- D with a meal is great as it is fat soluble so absorbs best with fatty foods. Did you know that D and magnesium work hand in hand, and taking them together helps both work better? Personally, I take them together with dinner. You can take folate with either or both too.
- I’ve also just started taking my iron at bedtime. I know heme is much less problematic than non heme, but I still like to give it a wide berth. Might give you an end of day option a few hours after dinner and your last probiotic. Iron and folate can also be taken together.
- fyi mag and iron definitely need to be 3-4 hours apart. 3 in a pinch. 4 is better. These are both minerals that compete for absorption.
I know nothing about your probiotics…
But I think you have some good flexibility.
Hi thanks very much for your reply. I've changed to having heme and folate at lunch, so 4 or 5 hours after levo/lio and 4 hours before my 2nd lio dose. Still working up from 2.5mcg each dose to 5 but going well so far so hopefully this will stay positive!
Defo I leave an hour between meds and breakfast. I do take my D3/K2 at breakfast though as this was recommended by my Vit D group which works alongside B12 society protocol for B12 injections. I can't take magnesium malate at lunch as hoped due to heme now, but like you I'd like to give heme a wide berth just incase it feels safer! Ive been so long waiting for T3 qnd getting so ill, which has also slowed my B12 deficiency recovery too, so dont want to tweak vits and mins as I go anymore really, unless this plan doesnt work of course haha.
I take mag glycinate at bed as with all the B12 cofactors they're very high dose and send me right to sleep! Fingers crossed this will continue well, I'm to increase to 5mcg in mornings in a couple of days so hopefully will go well, abit scary as im so sensitive but i settled quite quickly with 2.5 in the end so 🙏 thanks very much for all your help its much appreciated 😊
So good to hear the 2.5 is being tolerated!
When I got t3, my doctor put me on 10 (split 5 waking & 5 bedtime) and it was horrible with the palpitations for so long. My Levo was dropped from 50 to 25 at that time! Such a dumb move, my doctor was well intentioned but knew so little.
Ultimately I took a year-ish to titrate my Levo up… right now at 112 a day. But as I did my t3 pushed over range/over-replaced and I’ve just recently dropped t3 to 7.5 a day. I think 7.5 might be where I stay.
It’s amazing how a teeny tiny little pill can make such a difference!
Oh no that sounds awful, I'm so sorry you had little doctor support, it is such a delicate balance to get it right isnt it? I hope you find your sweet spot soon, it sounds like you're almost there.
It sadly seems v common most Dr's have no idea, my endo was pretty rubbish apart from acknowledging i needed T3 so i was glad for that at least. But he also wanted me to drop from 112 to 75mcg levo at same time too! He was so bad at getting prescriptions changed when I asked for it so I could get compounded, it all took months. So even though I eventually I got prescription I didn't drop levo and will be using compunding pharmacy prescriber next time. I did drop to 100 myself for 2 months before starting lio as I get palpitations above 100. I wonder if I'll need to drop again but for now thjnk will just see how gors with lio. I'm getting a little bit "palpitation - ey" the past couple days and heartburn as I've increased to somewhere between 2.5 and 4 and starting 5 tomorrow. But it's fairly subtle so I will stick it out and hope it settles, do you find it settles eventually?
Thanks so much for all your help 😊
My palpitation story is a funny one… you know there are so many nuances to what triggers it.
I know when i started 10 Lio a day the palpitations were immediate. And constant for about 9 months. But since I was at 25 Levo!!!! And I think my ft4 was like 10% through range. oh, and ferritin was 7 at that time!
I was so underwater …
As one of those people who has had terrible week 5 of a titration… but by weeks 6-7-8-9 everything would just settle down .
So all through that I was more reactive to the change against a low backdrop.
Then - as I said above - as my ft4 increased (now about 40-50%) it pushed ft3 absolutely over range.
A few weeks ago I reduced to 7.5 a day and within a week or two I am sleeping better, no more wired/tired. I’m a little more tired during the day. But still a few weeks before I make any solid conclusion.
having been on lio for over 4 years now, compared to around 20 years on levo before that, I can say that the interactions with lio are much more common than with levo.
Apologies, I don’t have time atm to read all of the above thread, and maybe as you’re starting lio and therefore balancing levels alongside existing supplements, it will be ok, but I have found introducing things really difficult.
For example, quercitin was a big no no for me. Made me really ill as if I’d dropped my T3 altogether. There are a few other things I’ve tried over the years and have had a really negative impact on my T3 absorption where I managed them fine alongside Levo with the same spacing etc.
Again, apologies for the brief reply, but I just wanted to pop on and warn you that T3 is so much more reactive to other things because of its short half life in comparison to levo, so to be careful! But as I say, maybe because you’re already established on these and introducing the T3 you might be able to balance it better. Good luck! T3 is life changing
Hi thanks so much for your reply. That's interesting its interacted more for you I'm sorry. Other people have said the opposite so that's interesting, did you find it reduced lio effects even if leaving it 4 hours away at all please?
I ask because I've changed to having heme and folate at lunch, so 4 to 5 hours after levo/lio and 4 hours before my 2nd lio dose. Still working up from 2.5mcg each dose to 5 but going well so far so hopefully this will stay positive for me and I won't have any worse effects like you did. I'm so sorry to hear it didn't help you how did you manage it all in the end?
I have been taking high doses of these vits and mins as part of a b12 deficiency injection protocol almost 18 months, so am well established like you say. I really hope that will be enough of a buffer and will keep a close on my levels going forward, I really appreciate you sharing thanks very much 😊
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