Pred and thyroxine

[Judigardener]

Hello

I've been reading that thyroxine is affected by taking Pred and calcium. Anyone Know if any current literature on this?

Thanks

[Annodomini]

I haven't read about this, but I've been on pred for over four years and thyroxine for much longer. My thyroid function bloods haven't indicated any problem during that time. Best keep an eye on it though.

Anno

[polkadotcom]

I've been on Pred for 13+ years and on throxine for much longer that that. No problems ever indicated through the years.

[alice1940]

I have been on pred since March started at 20m now on 9.5 .I too have been on thyroxine for a long time and just had a thyroid function test that has indicated no problems at all with taking pred .Alice

[PMRpro Ambassador]

There aren't any listed interactions for pred and thyroxine, calcium does interfere with pred absorption.

I found this response to a similar question, it's from a pharmacology student:

"When there isn't enough thyroid hormone, the body reacts in many different ways. Higher TSH levels and hair loss are some of the signs of a low thyroid hormone. TSH is the signal for the thyroid to release the thyroid hormone. In hypothyroidism there is only a small amount thyroid hormone to release. The body wants more thyroid hormone, so it releases lots of TSH in an effort to get enough thyroid hormone.

Prednisone or other corticosteroids can sometimes cause hypothyroidism or make it worse. There are a couple different ways that prednisone does this. First, normal doses of prednisone can stop TSH secretion, leading to less thyroid hormone in the body. Second, the thyroid hormone comes in two forms. The less active form is released from the thyroid. It is then converted in the body to the more active form. High doses of prednisone can slow the conversion of the hormone to the more active form. Both of these could result in hair loss or other symptoms that look like hypothyroidism.

The hypothyroidism or hyperthyroidism can also affect prednisone. People with hyperthyroidism may need to increase the dose of prednisone, while people with hypothyroidism may not need as big of a dose."

and this for thyroxine and calcium - it is from WebMD which I have found to be pretty reliable and non-sensationalist:

"Researchers report that calcium may interfere with the absorption of the most widely used therapy for this condition, and they raise a red flag that the two should not be taken together.

"Patients and their physicians need to be made aware that calcium can prevent the absorption of thyroxine" and this can be prevented by taking the two six to 12 hours apart, study author Jerome M. Hershman, MD, of the University of California Los Angeles School of Medicine, tells WebMD. Harshman and colleagues reported their findings in the June 7 issue of the Journal of the American Medical Association.

"Patients typically take both at breakfast, with the thyroxine being taken on an empty stomach before eating and the calcium being taken after eating," Hershman says. "Based on our findings, this probably should not be done."

An expert on thyroid therapy who was not involved with this study says taking the two drugs hours apart probably couldn't hurt, but it is not clear from this study if it is necessary. "The authors have shown that there may be an interaction here, but more study is needed to definitively prove this. "

So our standard advice of taking pred for breakfast and calcium at lunch and tea/evening meal will also work well for thyroxine since it should be taken either in the morning 30-60mins BEFORE food or at night.

But it is like all things that have to be titrated (adjusted for each patient) - as long as you always do the same thing it doesn't matter that much. You titrate the dose until you get the desired effect, if you don't move the goal posts too much the desired effect will continue.

[Hidden in reply to PMRpro]

Hi PMRpro, just wanted to say, 'what would we do without you' grateful for all your blogs. Peter.

[Judigardener]

Thanks for all this. Most grateful. J