hypothyroid folks: timing of taking thyroid medication & late-night effort

There's such a knowledgeable community of folks with thyroid issues here that I bet someone else has thought about this: does anyone modify their thyroid-medication schedule when planning things that go late into the night, especially athletic-y ones? I feel like I can feel the levothyroxine wearing off at about 11pm (I take it at about 7am normally), and I can definitely feel it kick in in the morning. So I'm wondering about what people do when doing brevets/other long rides that run late (or start in the middle of the night). Take the dose earlier/later? Take it on time and just deal with the exhaustion? Take smaller doses and spread throughout the day? (It looks like it's a safe pill to cut -- no fancy extended-release, though I'd obviously check with my doc about that.)

hmmmm, I've been taking this for decades and have never been able to "tell" when it "kicks in". I don't have a thyroid at all. Has your levels been tested recently? Just curious about this. I can tell a gradual difference if I forget to take it for a couple of days which DOES happen, but I've not experienced anything more noticeable than that. Of course all of our bodies are different!

Well, it could be psychosomatic, since I can't exactly hide the fact that I've taken it from myself. My levels were checked a few months ago, so I think they're still fine, and I still feel like they're fine.

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Originally Posted by antimony

Well, it could be psychosomatic, since I can't exactly hide the fact that I've taken it from myself. My levels were checked a few months ago, so I think they're still fine, and I still feel like they're fine.

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All that counts is they get checked occasionally :) It is certainly possible that you can tell something, all of our bodies are different. Just because I've never noticed it doesn't mean that you can't. It will be interesting to see what other feedback you get. To my mind keeping a consistent schedule is the best choice where thyroid medication is concerned.

I wouldn't try to chop it up and take smaller doses throughout the day. Sometimes when I forget to take it in the morning I will take it that evening when I get home, and then just return to my usual schedule the next day. You could always do that if this is a concern.

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Originally Posted by Catrin

All that counts is they get checked occasionally :) It is certainly possible that you can tell something, all of our bodies are different. Just because I've never noticed it doesn't mean that you can't. It will be interesting to see what other feedback you get. To my mind keeping a consistent schedule is the best choice where thyroid medication is concerned.

I wouldn't try to chop it up and take smaller doses throughout the day. Sometimes when I forget to take it in the morning I will take it that evening when I get home, and then just return to my usual schedule the next day. You could always do that if this is a concern.

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Yeah, I know it usually is best to be consistent, but 24hour+ events aren't really usual circumstances, either. I'm pretty sensitive to temperature, which is how I usually feel it kick in (and possibly why I wasn't diagnosed for a long time -- I am absolutely never cold, and had just thought I'd gotten somewhat more adult and able to be less whiny in the heat as I got older -- nope, turns out with my thyroid levels correct anything over 80 still makes me miserable).

I've done a number of 20- 24hr + events (400 - 600k brevets, double centuries that take too long, etc.). To be honest, sometimes I just forget to take the thyroid and I figure for a day it won't mess things up too badly. And it doesn't. I might throw in an extra 1/2 pill the next day if I miss a dose. I've been on this so long that I will self-adjust the dose within a slight window to account for where my weight it, etc.

My last 600k, I think I just put it in the saddle bag with the extra shorts I was going to change into after the sleep stop. I take mine at night, so it is a lot more of a cr@pshoot as to whether I will be able to take it or remember when I'm finishing an event at midnight or 2 am.

The half life of T4 (which is what I think you are taking since you said levothyroxine) is 5-7 days. That means that as long as you take it at ~ the same time daily, there should always be a similar constant amount of it in your bloodstream. You should not notice it 'wearing off'. T3 (cytomel) is a little different, its half life is only a day, and I do find if I take it too late in the day I will have trouble sleeping. So I take both my T4 and T3 first thing every morning, and have even energy throughout the day.

http://emedicine.medscape.com/article/819692-overview

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Originally Posted by Triskeliongirl

The half life of T4 (which is what I think you are taking since you said levothyroxine) is 5-7 days. That means that as long as you take it at ~ the same time daily, there should always be a similar constant amount of it in your bloodstream. You should not notice it 'wearing off'. T3 (cytomel) is a little different, its half life is only a day, and I do find if I take it too late in the day I will have trouble sleeping. So I take both my T4 and T3 first thing every morning, and have even energy throughout the day.

http://emedicine.medscape.com/article/819692-overview

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Do you think it's possible that the OP's sense of the levothyroxine wearing off is a sign that she could benefit from T3 replacement as well? I'm hyper, not hypo, so I'm not as well versed in hypothyroidism, but from what I've read, some docs are better at others at detecting and treating T4 to T3 conversion problems.

To the OP, when you doc check your thyroid levels, does she/he look at both Free T4 and Free T3 or does she/he look only at TSH? To get a complete picture, I'd make sure you get your Frees checked. If T3 is low relative to T4, I'd discuss T3 replacement therapies with the doctor.

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Originally Posted by Triskeliongirl

The half life of T4 (which is what I think you are taking since you said levothyroxine) is 5-7 days. That means that as long as you take it at ~ the same time daily, there should always be a similar constant amount of it in your bloodstream. You should not notice it 'wearing off'. T3 (cytomel) is a little different, its half life is only a day, and I do find if I take it too late in the day I will have trouble sleeping. So I take both my T4 and T3 first thing every morning, and have even energy throughout the day.

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Yeah, it's just T4. Huh. I really feel like I can feel it, but I guess it's likely psychosomatic. It may just be another case of where I'd forgotten what normal-me felt like -- this went undiagnosed for quite a while and I just thought that was what turning 30 was supposed to feel like. Or some sort of mild idiosyncratic reaction; my dad swears that as a kid he and his brothers could tell if my grandmother didn't take hers in the morning, and she was (and is) on T4. The crashing at 11pm I can't do much about except try to plow through lots of high-protein food around then, which seems to help; unfortunately that works better for non-athletic all-night efforts than it would on a brevet.

(The trigger for asking is that I'm doing a 200K that starts at 10pm the weekend after next, and I'd like to start doing longer brevets, though that won't happen until next spring as the 300-400Ks around here are all done for the year.)

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Originally Posted by indysteel

To the OP, when you doc check your thyroid levels, does she/he look at both Free T4 and Free T3 or does she/he look only at TSH? To get a complete picture, I'd make sure you get your Frees checked. If T3 is low relative to T4, I'd discuss T3 replacement therapies with the doctor.

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She's checked all my levels -- I seem to be OK converting T4 to T3, and the T4 is working great for me in general. It may be a case of having forgotten what normal tiredness feels like, IDK, since I was so exhausted for so long. My doc is fairly awesome with this stuff -- she caught it as soon as I started seeing her, and was all-for aggressively treating it even though I didn't think I had any symptoms. And she listened to me when I described how all the different dosages we tried felt, and with me pushing the dose up to get to a TSH of ~1.5 instead of ~2.5, whereas my previous doc said I couldn't be having any symptoms at ~4.5. (Which, at the time, I believed; I'd only had it tested because of a family history of thyroid issues. In retrospect, I was already suffering symptoms at that point.)

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Originally Posted by antimony

She's checked all my levels -- I seem to be OK converting T4 to T3, and the T4 is working great for me in general. It may be a case of having forgotten what normal tiredness feels like, IDK, since I was so exhausted for so long. My doc is fairly awesome with this stuff -- she caught it as soon as I started seeing her, and was all-for aggressively treating it even though I didn't think I had any symptoms. And she listened to me when I described how all the different dosages we tried felt, and with me pushing the dose up to get to a TSH of ~1.5 instead of ~2.5, whereas my previous doc said I couldn't be having any symptoms at ~4.5. (Which, at the time, I believed; I'd only had it tested because of a family history of thyroid issues. In retrospect, I was already suffering symptoms at that point.)

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That's great that you have a doc like that!!! I'm so glad for you, having struggled with finding a decent endo myself.

Have you talked to your doc about how you feel come 11 pm? Is it possible that the fatigue you're feeling is caused by something else? Is it possible that you're overtraining? Not enough food or hydration?

I do know what you mean about forgetting what normal feels like? I felt that way most of last year as we tried to regulate my thyroid levels. It took over a year to get them back to normal and I'm not sure how long before that they were abnormal. Several years perhaps? I was mildly hypo for several years before becoming hyper, but I didn't know that at the time because none of my docs thought to tell me that my TSH was over 3 and sometimes over 4.

I finally talked to my doc -- it wasn't worth making a special appointment, so I waited for my next annual. She said it's not abnormal (though not everyone does) to feel a burst of energy about a half-hour after taking it, as the initial spike of levothyroxine starts to convert. Then it evens out. The tiredness is almost assuredly normal fatigue, now that I have gotten used to "normal" again, and I can push past it if I need to.

She said she thinks there's no problem at all doing whatever I want on 24+ hour events, so long as it mostly averages out. And if I want a boost at 3am, go ahead and take it early, and not to worry about taking it on an empty stomach then.