Should i take cytomel at night

Dr Mark Vanderpump on Wed 19 Aug Despite levothyroxine being the treatment of choice for those with an underactive thyroid there are few guidelines in term of timing. Blog home. Please get in touch Phone: Email: [email protected]. Contact form Name:.

Consequently, many patients are instructed to take their levothyroxine on an empty stomach before breakfast and to wait up until an hour before eating. Some patients find this timing inconvenient. A prior study suggested that taking levothyroxine at bedtime was equally as effective in providing stable thyroid hormone levels.

The goal of this study was to compare the effect of taking levothyroxine at bedtime as opposed to taking it before breakfast. Effects of evening vs. Arch Intern Med. Create a personalised content profile. Measure ad performance. Select basic ads. Create a personalised ads profile. Select personalised ads. Apply market research to generate audience insights. Measure content performance. Develop and improve products. List of Partners vendors.

Managing an underactive thyroid gland requires you to take a thyroid drug every single day. Consistency is key, meaning it's important to take your thyroid pill at the same time daily.

Most are told to take their medication first thing in the morning, rather than before they go to sleep. But the truth is that either time of day works, although one time may better suit your lifestyle.

In addition, there is some research suggesting that taking your dose at bedtime may allow for better thyroid hormone absorption. Discuss when to take your thyroid medication with your healthcare provider. These pros and cons can help guide your conversation. Get our printable guide for your next healthcare provider's appointment to help you ask the right questions. Taking your thyroid hormone replacement medication most commonly, levothyroxine first thing in the morning with water and waiting at least an hour before eating breakfast or drinking coffee is what has been traditionally recommended for years by thyroid experts.

In addition to waiting an hour before eating food or drinking coffee, experts also recommend waiting at least three to four hours before taking any other medications or supplements that may interfere with levothyroxine's absorption. If you are taking fast-release LT3 alone , you may need to take one or two smaller booster doses or, a microdose through the mid-day to ensure distribution not letting your T3 levels plummet too far while creating the overall lopsided effect of a sine wave curve.

Without much if any FT4 in circulation as a foundation, there is little to no baseline T4-T3 conversion as a cushion to fall on. As you can see, the model is not perfect in the image below, where the 8AM purple line does not align on both sides of the image as it should. Nevertheless, even this misalignment at 8am visually represents the subjective experience of some patients: A strong FT3 at night seems to endure longer into the next day without symptoms of hypothyroidism.

If you are taking desiccated thyroid NDT , some patients have reported having a more gentle slow-release effect. This may be due to its being bound to thyroglobulin rather than sodium in the tablet. Therefore, depending on how your body absorbs it, instead of having a peak FT3 level 2.

Note that the estimates below are based on anecdotal evidence of the gentler effect of the T3 from NDT, since we do not have any published studies on desiccated thyroid dose pharmacokinetics. Evenly spaced doses will create a two-peak day. Three doses offers a little more flexibility. You could have two smaller doses and one large one, or one small and two large. Make your own plan. You could try drawing your own graph on a piece of paper.

Get out a pencil and a ruler. Put the timeline on the bottom. Create either dose-response curves from the 10 mcg LT3 Saravanan image above or approximate angles that peak. Some people had TSH peak 2. It is not like having a healthy thyroid that secretes directly into your bloodstream every minute of every day, at a flexible rate, on top of a flexible T4-T3 conversion rate across all your cells.

A pattern that works for many patients taking T3 is often a little time-shifted forward or backward from the natural FT3 circadian rhythm peak, simply because nobody enjoys waking up just to take a pill so that it will peak in bloodstream 2.

Why is it not too damaging? When we travel overseas to a new time zone, our bodies can adapt, though we do pay a price. You can force your body to wait more hours for your T3 peak to arrive, or you can force T3 to peak a little earlier than it would in perfect thyroid health, but your other hormones might not be very happy with you.

Shifting your T3 dosing schedule to conflict with your sleep and circadian rhythm may disrupt your melatonin rhythm, cortisol rhythm, and other rhythms. Each organ has its own clock. Just imagine how many 24 hour sine waves our bodies naturally manage! This is a growing field of medicine, and more science articles have been written on it since Nowadays, you can purchase devices that create a silent vibrating alarm on your wrist, and you can put a glass of water and pill on your night table as you go to bed.

Try to estimate roughly how many hours since rising, or after bedtime, your TSH would have risen if you were not dosing thyroid hormone. As for the health risks of breaking up your sleep schedule just to take a pill, risk is more about how many hours per day you get, not about whether you break up your sleep into shifts. Of course, it may create challenges for people who have sleep disorders.

But it might actually help you sleep, since the nighttime T3 is natural. Your body might want you to at least give it a try. Response to evening and nighttime T3 dosing varies among patients who dose various T4-T3 combos, or desiccated thyroid, or people on T3-only. Having a T3 prescription is a major biochemical tool, a blessing in disguise that can help us tweak many metabolic pathways. Therefore, a fundamental piece of education is to understand the T3 dose-driven rhythm as a tool see our FT3 Peaks and Valleys article, and T3 withdrawal article.

The FT3 peaks created by dosing will always be much higher than natural ones, even if you only take a small dose of 5 mcg. Our T3-T2 metabolism and T3 clearance rates can be different as well far more loss to two inactive types of T2 during the peaks. Keeping a record of vital signs we can measure heart rate, blood pressure, body temperature, symptoms can help us tweak the dose strength and timing to see what works best for us as an individual, but sometimes even measurable biomarkers like our heart rate can be difficult to read.

Even without a change in your total T3 dose per day, Paul Robinson and patient experience attest that simply moving a dose by minutes in relation to waking, sleeping or eating can shift what happens all over our bodies for the next 5 hours, or 5 days.

Some tissues exchange thyroid hormone with blood more slowly than others. Splitting pills and spreading out doses is a valid strategy. On the other hand, sometimes too small a dose is not enough to respond to the physiological need at that time of day. Each person has a different ideal T3 dosing rhythm not only because of genetic variation, but because of the variety of our disabilities.

Our non-thyroidal circadian rhythms can become time-shifted and de-synchronized during thyroid disease and therapy.

It takes time to learn what your body needs. Each of us has different physiological strengths and weaknesses. Your thyroid disability is unique. Therapy is adaptive, not a rigid prescription that is the same for everyone. It is our role to micromanage dosing schedules within the daily dosage our doctors prescribe. I am seeing too many tragic failures of T3 monotherapy lately. Those are not valid reasons. This is not based on science.

There are even some people who recommend keeping RT3 to the lowest two digits in the RT3 reference range or below. Reducing RT3 is not a valid therapy target.

Untreated hypothyroidism has an extremely low RT3; is the lowness of RT3 helping them? I could go on….