As “no thyroid” peeps we obviously have to take our thyroid hormone medications daily. I’ve read a lot of information and questions online about the correct way to take them. I’m always surprised at how complicated some sources try to make this. Darcey and I have done some research about this so I thought I’d write a quick post sharing what we have learned and of course provide you with some resource links so you can check it out for yourself. Knowledge is power!
Levothyroxine (T4)
Synthroid, Unithroid, Eltroxin are a few of the brand names of T4 medication and I am sure there are more. Or, maybe you take the generic like I do (levothyroxine).
Dosing time and other considerations for T4 medications
Most people take their T4 medication in the morning before breakfast. It is recommended that levothyroxine be taken 30-60 minutes before breakfast. That’s it, not 2 hours, not 4 hours, just 30-60 minutes. I think we can trust the American Thyroid Association and here is what they say about dose timing. And if you want to get all nerdy about it, there is also an interesting study about T4 absorption with regard to different foods, beverages and supplements.
Some people also have success taking their T4 at night before bed. There aren’t many things I haven’t tried, but I have never taken my Levo before bed and I’ll explain why. I have read numerous research studies about taking T4 at bedtime. The evidence clearly suggests that taking T4 medication before bed is as effective as taking it in the morning. But…. a few of the studies suggested that evening dosing of Levothyroxine increases T4 levels and lowers TSH levels and if you follow this blog then you know that I definitely don’t need that! So, I’m not taking any chances and I’ll stick with mornings.
So there you have it, morning or before bed, your choice. Pick what works best for you and stick with it. Consistency really is key. I take my T4 in the morning around 6 am and Darcey takes her T4 in the middle of the night when she gets up to use the bathroom.
Please remember, there really aren’t any thyroid rules that are enforced by the thyroid police. And actually, if you want to take your T4 with your coffee or breakfast every morning, go for it! Just know that you will probably have to increase your dose to account for lack of absorbency. You do you, boo.
Doses of Levothyroxine
Obviously there are many different doses available in T4 medications. There is usually every dose EXCEPT for the one you need! I’m convinced that doctors and drug companies are clueless in regards to the gaps in thyroid medication doses. Just a few micrograms can really have an impact on our levels. I mean seriously, 50 mcgs to 75 mcgs to 88 mcgs to 100 mcgs…. the disparity is huge when you don’t have a gland to help with the process.
There are a few ways to address this issue if you end up between manufactured doses. You can become a professional pill cutter (like Darcey) or you can increase or decrease your dose on certain days of the week (like me). Darcey takes the dye free white 50 mcg pills so she cuts her pills to get her 85 mcg dose daily. She is sensitive to dose changes so she feels better taking a consistent dose daily.
I generally like to stick with my 88 mcg pills. I had a bad experience a few years ago with the yellow 100 mcg tablets, so I stick with what my body is used to. I know from years of experience taking 88’s that I can count on consistent results. So, if I need a dose adjustment I just use my 88’s and either increase or decrease a 1/2 or 1/4 tablet on Sunday to get my weekly target medication level. I don’t notice a difference doing it this way, but everyone is different.
Pick whichever way feels the best for YOUR body and be consistent. If you are consistent then you will get reliable lab results and can adjust accordingly.
Liothyronine (T3)
Cytomel is the brand name of T3 medication or there is the generic, liothyronine. For simplicity I am only going to address the immediate release T3 here not the compounded slow release T3.
Dosing times and other considerations
If you read the Cytomel prescribing insert, there really isn’t very much information for patients taking it together with levothyroxine in combo therapy. In fact, a simple google search will get you useless results about dosing also; once a day dosing, taken away from food, doses starting at 25 mcgs! 🙁 Thus far, I have not found any official information in regards to keeping Cytomel/liothyronine away from food. I think we have to remember that what we are doing now with combo therapy doesn’t even have mainstream medical approval so there really isn’t a lot of reputable prescribing information available. You really have to dig a little deeper to find some relevant info that would pertain to those of us who are taking biologically equivalent doses of 5-10 mcgs of liothyronine along with our dose of T4.
In his book, Rethinking Hypothyroidism, Dr. Antonio Bianco recommends dosing T3 twice daily, in the morning and before bed (taking the largest dose before bed). The idea that liothyronine will keep you awake is not supported. There is also research to support that taking T3 before bed is a better match for our natural circadian rhythm. If we had a working thyroid gland it would be producing most of our T3 at night while we sleep.
So once again, do what feels best for you. One dose, two doses, three doses…. what ever gets the job done. If it feels better to take your dose or doses of T3 with food, then do it. If you are a lucky individual that doesn’t even feel their doses of T3 and you can take it without food, go for it. Either way, your levels will adjust to your consistency.
Doses of Liothyronine
Cytomel and Liothyronine come in 5 mcg and 25 mcg tablets. Because most of us are taking between 5 – 10 mcgs, the 5 mcg pills are the most familiar. Some generic brands are easier to cut than others. I stick with the Mayne brand of Liothyronine and it cuts decently. A good pill cutter is helpful. I didn’t even own one until I started on the T3 roller coaster, but now it’s my BFF.
Combination Therapy Considerations
I’ve also read a lot of speculation about taking Levothyroxine and Liothyronine together in the morning or separating them. This too is your decision. In my search for “rules” on this, again I found nothing from a reliable source. If it’s more convenient for you to take them together in the morning and you will be more consistent doing it that way, then do it.
I guess my message and hope for this post is that you will stress less about the how and when part of taking your meds. Trust me, I get it. Sometimes this journey can be overwhelming. We tend to second guess ourselves and wonder if we’re doing everything correctly. Life is hard enough without a thyroid, don’t make it harder by over complicating your medications. Please know that everything is going to be ok and your dosing is uniquely yours.
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