A couple of questions about thyroid meds and interaction with other things

I have a family member who is hypo and is on Levo ...50 I think is the dose. She recently had blood tests done and I pointed out all the things that need improving like ferritin needing to be around 70-90 etc. She told me she takes a multivitamin type tablet and she takes it with her thyroid meds in the morning and I of course went "noooooo you mustn't do that" as I have seen this mentioned lots of times. She then asked me what other things I recommend and as I have never been on thyroid meds before I wanted to check with those that know so that I can give her accurate info.


1)take thyroid meds in the morning with water. Does she have to have it away from food? How long after is ok to eat? She says normally 20 minutes later she is eating,is that too soon?

2)she also takes omeprazole with her Levo. Is that ok to do or should she take the omeprazole at a different time?

3) and just to make sure I have said the right thing about supplements, I told her to wait 4 hours before having her iron/multivitamin pills. Is that correct?

37 Replies

  • It's good you have taken an interest. She can either take her medication in the morning with one glass of water or at bedtime. She should wait at least minimum half hour before she has breakfast, some wait 1 hour. If bedtime dose, should take 2 hours after eating.

    Supplements should be 4 hours apart and omezaprole.

    How long as she been on 50mcg of levo as that is usually a starting dose? Can she get a copy of her latest blood test results with ranges that you can post to ask a question.

    If she has hypo, most times we have low acid rather than high and this is a link. Symptoms are very similar between high or low.


    How does she feel otherwise on 50mcg of levo? Some GP's are apt to be happy to keep us 'within range' but that doesn't suit everyone.

  • She started on 25 and then moved up to 50. I am not 100% sure but I think it was probably 3 years ago. She feels tired all the time and that is why I told her to get her ferritin,b12,folate etc tested. Doctor said all in range,all fine. I told her not to trust "normal" and to get the results and after many weeks I reminded her when she was going to the doctor for a different reason. Ferritin was around 40 (approx range 10-190) b12 was around 350 (again approx range 210-910). Folate was good, cholesterol was around 5.6 which I think is ok.

    I did ask her for the tft results but she said that they weren't repeated as she had had them done not long before for her yearly check. Is it normal to just check levels once a year by the way? Doctor was happy with results but I have told her that it can't be trusted and that it would be good to get the results. Not sure if she will try to get them as she told me they were being really difficult and unpleasant about printing out all the vitamin results.I will tell her that it is important especially if she feels unwell so that better advice can be given.

    So omeprazole should be taken away from levo! Why has the doctor not told her this when she prescribed the omeprazole?

    She's on the fodmap diet as she was having a lot of discomfort and had been for years. She is now feeling a lot better and has been on this diet for a year but she started getting pain on her left side and the doctor prescribed omeprazole. She says it has helped but she still gets the pain from time to time.

    Thanks for the link and your help shaws. Shall pass it all on to her.

  • She has to get a copy of her blood test results. For the thyroid gland it is the only time I have asked for the results as I now know many GP's diagnose only on the results and it didn't correspond with how I felt.

    I cannot get access to the archived site (being serviced) I use to link to different problems but I do know (many who are on 50mcg) he said that low doses ,i.e. 50mcg and 75mcg can actually make symptoms worse and as soon as I can access it, I will send you the link. It is very important we have optimum meds as Dr Lowe said that, if not, there is a likelihood we can develop other 'more' serious diseases, i.e. heart, cancer, etc. In any case we will find that we are dispensed more medications (not thyroid) for clinical symptoms as they are diagnosed as not connected to the thyroid gland.

    Her doctor, who has deemed her tests as 'normal' (they may be within the normal range) but obviously they are not normal for her. Therefore a copy of the latest thyroid gland blood tests are needed for other members to make comments on them too. I am well, thank God, but I am not on levo which was a nightmare for me and my family. Many do well but it has to be at a level which makes you feel well, not if you have clinical symptoms.

  • hello shaws .I need your advice.i received in the post today a letter from my gp which comments on the fact that I did agree not to go the internet anymore but I still need this site to keep me sane.

    he lists the investigations I have had in 2012 and diagnostic laparoscopy in august last year when had gallbladder removed,a ct angiogram(?)ct scan of head and sinuses and blood s.

    he says that the only time T3 and T4 are checked is when TSH is abnormal.auto immune tests have been negative and ca125 has dropped from 105 -37(dec).strange that as hospital results were 15 in oct and 14 this month.

    it still leaves the fact that over the last 2.5 years he has not accepted that my weight gain is abdominal and I have suddenly lost weight elsewhere 3 times.and they are not recognizing physical symptoms -eyebrow hair loss,skin rashes,swollen lips,more swollen abdomen and that it is a hard solid mass.that something is causing pressure on my ribs and the pelvic pain is so bad-with both I can barely walk .walking uphill is out,i know when i see him next I will just breakdown in tears.i have showed him questions in the past and he hasn't answered them.i almost went back to A&E this morning -then thought I dont have the chest pain today altho pelvic pain is disabling.

    what shall i do if he still wont recognize that any weight gain is caused by whatever is making my stomach swell.

    I have told him things have got worse since sept 2011 after being stable before that and also since my gallbladder op.

  • I think it's inappropriate for your gp to suggest/ask you to agree that you should 'not go to the internet anymore' especially when you don't feel well and all he can suggest is what is NOT to blame but offers no solutions. Is there a different gp you could see?

  • gps in same practice have access to my notes and refer to what my own gp has written so what he says goes??story of my life being told what things are not nto what they are

  • my gp is only going on results and ignoring symptoms.

  • It is very problematic for you as when we go to a doctor with different ailments I think they believe we are hypochondriacs when we are nothing of the sort.

    I don't know if you can afford a private T3 blood test. It is done with a pin-prick, I believe, with Blue Horizon and you get a small discount if you put in the Thyroiduk code number.

    I will p.m. you.

  • thanks

  • do oyu know the cost?and how to go about it

  • This is a link:-




    I am not sure what he means that you can pay £29.50 for as many tests so you could phone for clarification.

  • Thank you Shaws. How interesting about the low dose and symptoms link. Would be really interested to read that when you are able to access it.

    I have stressed to her how important it is to get her thyroid test results so that we have a full picture to work with. Was having trouble accessing this thread earlier but I deleted my history and that seems to have done the trick. Have started another thread in the meantime cause I couldn't reply to this one. Here is the link healthunlocked.com/thyroidu...

  • Levo with water only 1 hour before or two hours after food. Morning or bedtime as preferred.

    All meds and supplements 2 hours away from Levo and iron and calcium 4 hours away from Levo.

    PPI's like omeprazole are damaging long term, reducing stomach acid until it is insufficent to obtain nutrients and absorb meds via the gut.

    Apple cider vinegar in fruit juic before meals is advocated as a gentler and less damaging acid suppressant. ostlerscidermill.co.uk

  • Does the same apply to NDT as to Levo? I thought not, but I have no idea where I have heard that!

  • It's not the Levo, per se, but the thyroxine hormone replacement which is the important thing, Harry, so yes, it applies to NDT, too. Schools out on T3 monotherapy but some believe the same protocols should be followed.

  • Oh, thanks for that :-)

  • I can tell you from experience that taking NDT after breakfast helped me get a "smoother ride" from the T3 in my 90 mg twice a day dosing. if i have it on empty stomach I get one heck of a buzzing hot flash type of feeling about 30 mins to an hour after taking it. And I HAVE to eat within 30 minutes of waking otherwise I get low blood sugar and then my day is ruined. Apparently t3 is not affected by food and actually many functional medicine docs now say to take half your dose in the am after breakfast and the other half after dinner.

  • My mum takes ndt away from everything (water only on empty stomach).

  • Thanks

  • So in essence taking omeprazole could be stopping her body from absorbing the supplements she is taking?

    I wonder if she can have apple cider vinegar...I suspect not because of the apple which is on her "do not eat" list on her fodmap diet booklet. She has told me that she wants to try stopping the omeprazole to see if she still needs it.

  • If Omeprazole isn't inhibiting absorption now, long term use will. GPs have been advised to reduce prescriptions for Omeprazole and reduce dose with an eventual view to getting px off it. It's the widest prescribed medicine in Scotland.

    If your relative's GP practice is difficult about providing photocopies of TFT results, tell your relly to request an appointment to view her online data and make the notes she requires. This should be foc. It changed the prickly and unhelpful attitude when I made this request at my practice.

  • Thanks Clutter...will pass all of this on to her. I'm sure she will be even more convinced to stop the omeprazole now. I think she has been on it for almost a year, pretty sure she went on it not long after starting the fodmap diet or maybe even before it so that is probably far too long!

  • She'll almost certainly feel the initial acid/reflux symptoms she had when prescribed. Reducing the amount and frequency is probably the best way to start plus the ACV if she can incorporate into her diet.

  • Will tell her not to go cold turkey then and to wean off slowly to see how it goes.Thanks again for the advice,much appreciated :)

  • It can be a painful process coming off omeprazole.

    Most people who have burning gut pain and/or reflux after eating actually have too little acid rather than too much, but from the patient's point of view it can feel very similar and they will assume they have too much acid - their doctor may assume the same or may not even know about the effects of too little acid. With too little acid the food ferments rather than being digested properly. The valve that opens to release food from the stomach into the intestines doesn't work well when the stomach is not acid enough.

    Apple cider vinegar is a common thing for people to take to increase acidity in the stomach. Another thing that people use (I use it myself) is Betaine Hydrochloride or Betaine HCl. It is often sold with Pepsin included which helps to break down proteins. It doesn't require a prescription.

    Betaine HCl often comes in doses of around 600mg per capsule. I take one capsule at the start of a meal. It can be a very scary thing to do, deliberately taking extra acid if your stomach has been burning for years after food. But it is worth persevering with. Stomach acid is vital in helping us to get nutrients out of food, and also helps to keep the stomach sterile, and once you adapt you definitely feel better.


    Hope this helps. :)

  • I seem to have put a very similar post & link! :D

  • That means the advice and suggestions have double the value! :D ;)

  • Hi humanbean thank you for your input. The too little acid really makes sense with her symptoms. She was put on the fodmap diet because she had suffered with discomfort in her stomach and intestines,increased flatulence and as many as 4 bowel movements x day for quite a long time. The diet has been incredible for her as she feels so much better now. But she still gets this pain in her left side (about an inch or so higher than the bellybutton area and to the left) especially in the evening but not every day. I have advised to keep a diary of her meals and symptoms for a few weeks to see if we can pinpoint what causes the symptoms.

    Thank you for the link too. Will pass it on to her.

  • ACV is diluted with water and there are a couple of other 'natural' things which may help. Detailed in the link I gave above.

  • also come s in tablet form

  • my dr switched me to lansoprazole when A&E dr saids to stop omeprazole

  • Omeprazole and lansoprazole are both proton pump inhibitors (PPIs) and they both do the same job. By changing from one to another nothing much has really changed. You would probably be much healthier and better off in the long term if you could come off the lansoprazole, unless there is some reason other than burning gut or reflux problems for you taking it. If you read the various links people have given in this thread, about how too little acid in the stomach causes the same symptoms as too much, and start taking betaine hydrochloride and/or digestive enzymes instead of the proton pump inhibitors you will probably feel much better, but it can be a painful process to make the switch. It is particularly difficult if the PPIs have caused erosion in your stomach lining. The stomach lining really has to be given a chance to heal before adding acid.

    If I have acid problems now, which happens if I forget my betaine hydrochloride pills, or I run out of them, I use Slippery Elm to help me through. It coats the stomach in some way and cuts down on pain. I much prefer the slippery elm to Gaviscon or anything of that sort.

  • I should have added that 1/4 to 1/2 tsp bicarbonate of soda added to ACV and fruit juice makes a good indigestion reliever.

  • Sorry can't find the link I'm after, for the long-term effects of PPIs, e.g. it depletes Magnesium...here's Dr Myhill...


    And I know of several who have tried to get off them or been changed to ranitidine - stomach acid is supposed to be there! It's purpose is killing nasties, absorbing and digesting food - otherwise undigested food just goes into your gut and rots! yuk! Stomach acid naturally lessens as we get older - I always wondered why the older generation loved their pickles! Hubby has painful indigestion & succumbed to these pills - but the simple thing for him was just to avoid bread, pastry, biscuits (he's probably gluten intolerant but doesn't trust docs!) it was hard getting off them 'tho - they get you hooked!

    I can't imagine that apples are bad for us - OK maybe if you had lots! There's many reports that apple cider vinegar helps digestion or betaine HCL.(yes enzymes and acid!)

    Well done you for trying to help - can she join us? I realise it's quite overwhelming for newcomers now - there are so many levels of discussion, but if you search for 'newbie' it is somewhere to start.

    Good that she's getting vitamins sorted to help absorption of Levo (yes ferritin over 70, B12 over 500 really and Vit D over 80nmol/l. I agree that 50 Levo is only a starting dose, but there's lots of suggestions for optimising it's effect!

    Best wishes Jane :D

  • Hi Jane thank you for your help and advice. You just reminded me that she hasn't had vitamin d tested and that should be checked too.

    Apples are a problem for her,she can't eat them (makes her very gassy)so I need to find out if the vinegar would be ok for her. I know that cider causes her problems too so not sure if the vinegar would be the same.

    I'll suggest joining but I think she's happy for me to do it for her for now. I'll start with sending her links that everyone has posted on here and then see if she then feels like joining.

  • Here's a few more links re. PPIs & magnesium

    Advice to GPs - Medicines and Healthcare products Regulatory Agency (MHRA)




    Low stomach acid test


    Also has she had a test for HPylori?? just a thought J :D

  • HPylori yes, forgot to mention this, she had that done but not recently. Came back clear.

    Thanks for the links. I have a lot reading to do :D The more I read the more I think that perhaps she shouldn't be on that medication! If anything I am learning that if I am ever offered it I should stay clear of it!!!

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