dosage & timing

[pfjourney]

Hi.  I just discovered this forum while googling a change from Armour thyroid (90 mg) to Nature Thyroid, 1.5 grain.  I found earlier posts that explained that the strengths vary from brand to brand.  I was never aware of this, and my prescriptions have been filled with different brands at different times. I was also never aware that I could divide the dose and take it twice (or more) a day.
I started several years ago on just 30 mg, then went up to 60 last year, and 90 ten days ago.  I spent 2 months completely wiped out before finally getting to an endocrinologist for labs, and discovering my T4 was low and T3 and TSH somewhat. I've been in Argentina, away from my naturopath, but sent her my labs and she recommended the increase.  I had both the Armour and Nature thyroid with me.  I have severe Seasonal Affective Disorder, with the symptoms being the same as hypothyroid in terms of energy and brain function, and got hit by an atypical month and a half of rain as days wet getting shorter (it's fall down here in the S Hemisphere).  So it can be hard to sort out what's causing what in my body.  Getting exposed to allergens like mold can also do a number on me and keep me confused.  I also had to switch last year from Isocort, a desiccated product to stabilize my cortisol, that was discontinued, to cytozyme AD.  It's been a hard year in terms of energy and clear thinking.

Anyway, the fact that I've jumped from one brand to another without adjusting dosage may explain some of the up and down!  

I am definitely improved since increasing from 60 to 90 mg Armour 10 days ago, but not sufficiently.  What are your recommendations in terms of the equivalent dosage on nature thyroid, whether I should split the dosage in order to do better in the evening.  I have a hard time getting going most mornings, and a hard time in the evening.  Do you recommend I try increasing my dosage, and by how much and how soon?  I'm also inconsistent in the time I take the thyroid daily.  Does that matter, and does it matter whether I wait 30 minutes or longer before eating?

I'm really encouraged by finding this forum.  Thanks!!!

[pfjourney]

Thanks.  I think I'll try dividing my dose this weekend, and then try a slight increase so that I'll know what dosage to request from my doctor when I get back to the states in 3 weeks.  I'll keep posted.

[ahmee]

I disagree that you have to wait longer to raise your dose. You can feel the bulk of the effect of desiccated meds within a few days to a week IMO. Since you are still feeling symptomatic, I doubt the subtle boost of T4 will bring you to the right place. This is just my opinion, based on how it was for me raising my dose of Naturethroid, and it's true that everyone is different. I raised 1/4 grain (15mg) at a time, about every 2 weeks. I slowed down once I got to 2 grains, but still had to raise from there. I agree with goolarra to just pick one brand and stick with it.

What I do: a.m. dose of Naturethroid upon waking, wait at least 30min before eating. afternoon dose around lunch, before or after it doesn't really matter, but I don't take it at the exact same time that I eat... again, just personal preference there. I take iron, calcium, magnesium, zinc, etc in the evening so as not to interfere with thyroid med absorption. Fat-based vitamins like A, D, K I take whenever, usually around mid-day or later.

[goolarra]

You really have to give it more than 10 days before you make any judgments.  The T4 portion of desiccated will take 4-6 weeks to reach its full potential in your blood.

Most people do split the dose.  When taking desiccated, you are basically relying on the T3 in it to get you through the day.  T3 is very fast-acting, peaking a few hours after you take it and then being completely neutralized by your body a few hours after that.  So, most people find that taking more than one partial dose keeps levels and energy steadier.  Most people take the second half dose around noon or early afternoon.  Depending on schedule, of course, you might want to avoid taking it much later than about 3 pm since it can interfere with sleep.

90 mg NT is considered equivalent to 1.5 grains Armour.  All desiccated products vary a little, but there is no "rule" on changing from one to the other.  Some people do better on one brand over another.  You just have to experiment and see where you feel best.

Please post recent labs with reference ranges (they vary lab to lab and have to come from your own lab report).  I can then comment on whether it looks like you need an increase.

You should be as consistent as possible in when you take your meds.  You don't have to get crazy..."when you get up" is close enough (unless that varies wildly).  The rule of thumb is to wait 30-60 minutes after taking meds before eating or drinking anything.  Some of us adhere to that rule, others don't.  If you tend to have an issue absorbing, then, yes, you want to wait.  Food, especially fiber, is the worst offender, but coffee can also impact absorption.  I want my coffee first thing in the morning.  If it affects absorption, as far as I can see (and my endo agrees), so what if I have to take a little more meds to compensate.  However, if as you said, you have a hard time getting going in the morning, you might want to let those meds get into your bloodstream before you eat anything.