changing timing of liothyronine - looking for experience please

[Sircharles]

hi!

I’m on levothyroxine (200) & liothyronine (20). I’ve had a suppressed TSH since adding liothyronine to my meds in 2015.

I used to see an NHS consultant at the hospital once a year. Last time we spoke in 2021/22 he said I knew more than him and so I didn’t need to see him anymore unless the GP refused to prescribe or something happened and I wanted to consult him.

My NHS GP is flipping out about the suppressed TSH. Seemed to not know I was under a NHS consultant for it and kept telling me to go back to my private consultant.!!

Anyway. Referred me back to the hospital. And they have set it up as a new patient referral. So I saw a different consultant.

She has asked me to split my T3 dose. Into 2.

2x10mcg per day.

I cannot see how this changes the suppressed TSH but anyway.

I had asked her to INCREASE my t3 to 25 mcg per day and reduce my levothyroxine. She was not convinced.

In 2015 I was on 25 lio and 150-175 Levo. I felt amazing. And lost 20kgs. I’d love to get back there but NHS does not seem interested.

In the meantime I will try the split dose.

Any recommendations on what time to take the 2nd dose?

and does anyone split it into 3 doses? How does that suit you?

basically looking for insights!!!

[Hypopotamus]

If I had my way, any doctor that didn't know about T3 suppressing TSH would be sacked immediately. I don't see that splitting the dose will make any difference, but if you want to try it, I would suggest one hour before your evening meal for the second dose.

Until thyroxine came along, doctors went on how the patient felt as regards dosing. These days, the blood test results dictate everything, and thousands of people go on feeling unwell as a result. If it was me, I would buy the extra T3 myself (I do buy my own NDT). At least you know the dose that makes you feel well.

[ZeldaR]

Hi,

When I first was prescribed T3, about ten years ago, I used to take the whole dose first thing in the morning with my T4. After a few years of dose and timing adjustments -- I'm now on 125mcg T4 and 20mcg T3 -- I found that splitting the T3, taking 10mcg in the morning with my T4 and the other half at 5pm, works best at keeping me and especially my brain functional for the whole day. Fortunately I have a private Endo who doesn't panic at the sight of low TSH, and who's been great at helping me to find an approach that makes me better rather than worse.

I'm sure there are people who do fine with once a day T3, though as you can see from my story, it wouldn't harm to try the twice a day suggestion. But you should do what works best for you, which I know is not easy when the doctors are so clueless. And you're absolutely right: your TSH is very unlikely to suddenly rise drastically, regardless of whether you take T3 several times per day or not. In my case, my TSH went below range since I started on T4, and I became extremely unwell because my GP of the time was obsessed with TSH and he dropped my T4 to 50mcg per day. Needless to say I've been avoiding that GP ever since!

I'm holding thumbs that your next appointment brings solutions and not more problems.

Z

[Sircharles in reply to ZeldaR]

thx ZeldaR. Pls Would you dm me the name of your endo? Thx

[SlowDragon Ambassador]

Please add your most recent thyroid and vitamin results

What vitamin supplements are you taking

Always test early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

Personally after loads of experiments

I now split my Levo as 2 doses waking and bedtime. (always Vencamil- lactose free)

And split my T3 as 4 doses (4 x 5mcg) always Teva - lactose free

But my TSH is still suppressed

[serenfach]

Good afternoon, Sir. The half life of Lio is around 5 to 6 hours, so it makes sense to split it so the body gets a smoother supply and you dont get that evening zombie feeling. I took mine first thing, and then late evening.

Send your GP this:- thyroidpatients.ca/2019/03/...

She cannot really argue with the guy who invented the test! Think about buying your own to top up the NHS starvation.

[Noelnoel]

I cannot see how this changes the suppressed TSH but anyway

TSH level may or may not change but how you feel could. Splitting my dose helped me enormously; I now sleep much better and after some much needed weight loss my weight has stabilised, though I could still do with shedding a stone

In 2015 I was on 25 lio and 150-175 Levo. I felt amazing. And lost 20kgs. I’d love to get back there but NHS does not seem interested

2015 is a long time ago as a point of reference and what suited you then is likely to have changed. Maybe not drastically but some…

Why not give the split dose a chance, watch and wait and if the status quo remains or you feel worse, have another discussion