Evening or morning dose of Levo?

[Adam10]

My endo insists that I take my daily Levothyroxine dose, 100 mcg Eltroxin, in the morning for best absorption. But this clashes with my need to eat breakfast before work or drink morning coffee. My Endo says leave 30-40 minutes after taking Levo. I need to take other medication (statins) and supplements (fit D and C) evening and morning. But I saw recent posts about leaving 2-4 hours before and after taking daily Levo dose. I fast in the evenings for weight control so would prefer to take in the evenings. Is there a good time? I would appreciate people\s views about time intervals before and after taking Levo. Thank you.

[Learner1]

I've had no problem taking levo when I wake up first thing, then shower, dress, and go downstairs to make coffee and breakfast and take other supplements.

Sometimes it's 20 min. other times it's 40, and I don't notice a difference.

As for the statin, they are notorious for depleting CoQ10, essential for mitochondria, which make your body's energy. You didn't mention taking it, but its irresponsible for any doctor to prescribe a statin without CoQ10.

Additionally, cholesterol is essential for all sex hormone production, including testosterone, DHEA, pregnenolone, cortisol, and female hormones.... if you drop cholesterol, you compromise hormone production which can have great consequences for your mental and physical health.

Too many carbohydrates in the diet and too much alcohol can promote higher cholesterol numbers and especially triglycerides.

You may want to do some research about the risks of statins and the dubiousness of their health promotion before deciding that they're the best strategy for you. There are some benefits, but for most people the risks outweigh them.

Don't stop all at once, all I'm saying is educate yourself, and discuss with your doctor.

[Marymary7 in reply to Learner1]

I so agree with this great advice from Learner1 read 'Spacedoc' online about Statins, Duane Graveline a space surgeon has lots of info and experts on there....so much information. The whole hypothesis is wrong about cholesterol.

I take my thyroid meds at both ends of the day, start and finish on an empty stomach.

[Adam10 in reply to Marymary7]

Thank you Marymary7. I had wondered about the statins. I obediently followed my Endo's advice about taking them. I will think again. I will also research cholesterol, which is persistently high for me but always has been, long before i was diagnosed with Hasimoto's. I like the idea of taking my Levo medication at the end of the day too. I'm switching as of now. Thank you.

[Adam10 in reply to Learner1]

Many thanks Learner1. Great stuff. Have noted all your points and will research them. Hadn't realised cholesterol affects sex hormones. My cholesterol is high at 5.8 mmol/L (range 3 - 5.2) but my free testosterone is low at 0.24 nmol/L (range 0.31 - 1.04). I'm taking testosterone replacement therapy too (injection of 1,000 mg per 3 months), so things are complicated. I noticed my TSH increased from 0.8 uiM/ml to 1.74 (range 0.27 - 4.2). I suffer fatigue and loss of energy/libido. Thank you again for your concern and comments. Much appreciated.

[Learner1 in reply to Adam10]

The statin drug company lobbyists have done a great job lowering cholesterol ranges so that what used to be normal is regarded as high so they can sell more drugs.

Your cholesterol is not horrendously high, it could be a good deal higher without worrying. And it might help you make testosterone. Please do gave your other hormone metabolites checked as I mentioned.

You might also Google Ancel Keyes margarine and rabbits....

And look into natural testosterone raising strategies, like resistance training and dietary modification. Testosterone supplementation can be very helpful, but it warrants being careful, too, to not promote cancer, do educate yourself to make the best choices for you.

Best wishes!

[milkwoman]

Going against the majority of answers you are sure to receive, I take my Levo at 5:00pm every day, along with my lupus meds.

For one, taking it at this time doesn't interfere with any supplements (which I take in the morning) and two, it seems to prevent the dreaded weight gain most folks associate with being placed upon Levo, and three, it doesn't interfere with my sleep.

Since my lupus meds can cause stomach upset, I typically eat a few crackers or a rice cake at the same time. Shocking I know!

This simply works for me and it is the way my private endo (Dr. Kenneth Blanchard in the US) has always had me do it based upon experience of his 1500+ patients.

I take 100 mcg Tirosint brand of Levo daily.

[Jbsa70 in reply to milkwoman]

Hi, more then year ago my Endocrinologist (in UK) suggested to me to try taking my Levothyroxine in the evening on empty stomach, saying some people find that more helpful. I tried that, taking Levothyroxine around or just before midnight, 4 hours after any food I had, and found that very helpful. It also helped with my morning medication routine as it used to be really difficult how to time all my different morning medication before going to work (I have Addisons Disease, Hashimoto Hypothyroidism and year ago I had severe deficiency of vitamin D and iron). Taking my Levothyroxine in the evening made,my morning much easier.

[vandewalle0 in reply to Jbsa70]

Hi all ive started to take my levo at night because its on an empty stomach and ive found I don't crave food so much .In the morning I was always starving for the day it definitely increased my appetite. I take 75 levo and 20 liothyronine at night and then 20 lio in the afternoon. Works well for me .

[Adam10 in reply to vandewalle0]

Thank you vandewallet0. I have switched back to taking my Levo at night on an empty stomach. I can't wait for food in the morning too.

[Adam10 in reply to milkwoman]

Thank you Milkwoman. It is interesting to hear about your private endo. 1,500 patients is an impressive number. My endo is not as experienced and is from the Middle East where I currently work. When ever I mention what I read on HealthUnlocked, it puzzles him. He seems focused on pituitary gland and considers my hashimotos is secondary, and sees no purposes for example in my asking for tests for FT3, FT4, and antibody (TPO and TG), Ferritin, Folate etc. I am not in the Middle East for much longer so will start my search anew for an Endo. Skype consultations might be the way forward.

[Redditch in reply to milkwoman]

" the dreaded weight gain that most folks associate with being placed on Levo"

You have obviously picked this up yourself without a "study" to prove it, but to you, one of the primary symptoms of hypothyroidism isn't addressed by the primary drug of choice that's SUPPOSED to do just that.

You are so right, Levo is not the wonder drug they would have us believe, it's cheap, but I have NEVER met ANYONE who does really well on it.

If you've worked out that it DOES work at 5pm, you may just have cracked it. Have you shared this info with the manufacturers? Can we get a sample group off the forum to give it a go? This could be very important

[Redditch]

Firstly, stop fasting in the evening you're hypo not fat, the weight will come off when you get your medication right

Supplements and Levo can be taken together except for Calcium who should be 4 hrs apart

Breakfast is super important, can't you pop your levo when you arrive at work?

Levo didn't work for me at all.

I take my Erfa with a load of supplements at the same time as breakfast. Not a problem,

Do what the doc says for a week, get a blood test and see if he's right.

[Adam10 in reply to Redditch]

Thank you Redditch. Yes, I am overweight and can't shake off the extra 10 kg despite daily trips to the gym. I have been thinking of trying T3 but can't get it where I work and live at present. My fatigue and lack of libido persists despite my 100 mcg daily Eltroxin Levo so I am hoping different medication will help me.

[SlowDragon Administrator]

I moved to taking Levo at bedtime, (on recommendation of extremely senior professor) and not only found it easier and more convenient but it also works much better.

Many find the same. So much so you may need a blood test to check levels 6-8 weeks after changing, it can be equivalent on a small dose increase.

On rare occasions if eating late, just take in middle of night, when get up for the loo.

Lots on here take at bedtime or in middle of night

There is lots of research to back up that taking in evening can work better

verywell.com/should-i-take-...


archinte.jamanetwork.com/ar...

Long research article - final conclusion paragraph below

"In conclusion, bedtime intake of levothyroxine in our study significantly improved thyroid hormone levels. This may be explained by better gastrointestinal bioavailability at night or by less uptake interference by food or medications. As shown in this study, bedtime administration is more convenient for many patients. Clinicians should inform their patients about the possibility of taking levothyroxine at bedtime. A prolonged period of bedtime levothyroxine therapy may be required for a change in quality of life to occur."

Levo really should not be taken with anything else, apart from possibly vitamin C. (Some research suggests vitamin C can perhaps improve uptake, perhaps as it increases stomach acidity) Definitely take 4 hours away from vitamin D, iron & calcium. At least 2 hours after last eating and nothing apart from water for at least an hour after.

endocrine.org/news-room/pre...

[helvella Administrator Thyroid UK in reply to SlowDragon]

Have to say, the vitamin C studies I have read are suggestive but don't appear conclusive. I'd like to see some much more rigorous testing.

[Adam10 in reply to SlowDragon]

Thank you SlowDragon. What fantastic websites you referred to. VeryWell.com is one of the best I have ever read. So authoritative. It is clear to me that taking Levo at night is best, which is what I was doing before my new Endo persuaded me to change back to morning. I think I suffered a 1.0 uiU/ml increase in my TSH level from this, although I have also been taking testosterone replacement therapy injections which another commentator said dilutes the Levo thereby raising the TSH. I have received so many helpful comments from so many experienced and knowledgeable people, thank you all.

[Babaji1971]

I find for me personally I have to leave an hour gap after I take my thyroxine before I eat anything. My doctor told me any supplements esp calcium and iron should be taken about 4 hours later. Any of my other prescription medication I take 2 hours after my thyroxine. I also cannot take thyroxine at night as I take a statin.

[Tarry]

Take it in the evening and lie to endo 😂😂. Lots of us take it last thing at night. I do. It'll be fine!

[sprucegirl]

My endo suggested taking my thyroid meds at bedtime after finding a small study where it came out that they were better absorbed through the night. I've been taking them for years at bedtime, it works fine for me.

[Jmsho]

I take my levo at night, currently around 2 or 3 am when I wake up and go to the toilet, but am thinking of trying changing it to 10.30 or so when I go to bed just to try a more consistent timing. I find taking it at night better than in the morning re timing with other supplements, coffee etc, and it has not made a difference to how I feel, or test results. I switched after hearing from some others online that they did this, and tried it out, doctor and pharmacist made no objections when I eventually told them what I had decided to do.

Can your endo tell you why it is better absorbed in the morning, to help you decide whether to follow his advice?

[Chippysue]

This endo has no right to insist!!! It's your body!!!

Taking Levo at night has been better for many people. Do what is right for you!

Statins - I cannot see that you will feel well taking these, please do your research, Dr Malcolm Kendrick - the cholesterol con.

[Marymary7 in reply to Chippysue]

And Spacdoc online....Statins the great con that will be the scandal of the future.

[Cathy777]

I have been discussing this on here recently and in similar position. It varies from person to person so I don't think it matters am or pm. I take lots of drugs morning and night so it was a problem. Someone said that some take it in middle of night....if you get up to pee e.g. I have now started doing this and so far so good.

[Bellsonit]

Hi this is an interesting topic, I always take mine on the morning but is that better? I generally wake, take it alongside citalopram and the I'll probably have a cup of tea within about 15/20 mins? I avoid coffee until later.

Will my citalopram have an affect on its absorption?

I do it morning as assumed this was the best time? Am I wrong in thinking this?

[Jolouise13 in reply to Bellsonit]

I take Citalopram and levo first thing in the morning too so I'd be interested to know whether it makes a difference. I'm always tired and constantly getting colds and viruses. I have trouble concentrating and a terrible memory. Could these be symptoms too?

[Hidden]

I take my Levo anywhere between 1-3 a.m. in the night as I always wake then. Taking it first thing doesn't work for me as I have to take pain meds then, with food, and elsewhere in the day it clashes with supplements, meds or food, so I find that works best. I told my doctor I do this and she was mildly surprised but understood why and didn't try to force me to change (good luck with that!).

Take your Levo when it suits you, is my advice, I honestly don't think it matters too much provided you keep it away from your other medication and supplements.

[greygoose]

The general rule is : on an empty stomach, one hour before eating or 2/3 hours after.

People will tell you all sorts of things, making statements like 'I take my levo with a gallon of coffee and then eat a whole roast pig! hasn't done me any harm!'. But, the point is, they don't know if it has done any 'harm', because, for the most part, they've never tried it any other way.

The thing is, T4 can bind with certain nutrients. Now, that isn't going to give you convulsions, or make your left leg drop off, but it will mean that you won't be getting the full dose of T4, because your body cannot use the bound T4.

So, common sense dictates that you take it away from food - as mentioned above - two hours away from other medication or supplements (like statins - why are you taking those, anyway?) and four hours away from iron, calcium, vit D3 and magnesium.

It actually doesn't matter what time of the day you take it - your endo is just being boorish - but some people feel it works better when they take it at night - and it can be far more convenient, of course. But, in the end, like all of us, you have to work out what's best for you.

[CSmithLadd]

Thyroxine takes time to become effective: anywhere from one to three weeks is usual. Therefore you really don't have to be rigid about when you take it, just as long as it is on an empty stomach.

Many prefer taking it at bedtime. For some, it takes away all the usual concerns as to how much time to wait before coffee or food in the morning. If that is worrisome to you as well, then by all means take it at night. Makes a huge difference for many. You might find you sleep better not having to subconsciously think about your morning dose.

Hope this helps!

[CSmithLadd]

Thought this might be helpful to you as well.

"Switch to Bedtime

Why not take your levothyroxine at bedtime? A small study showed that the drug is absorbed better in the evening (Clinical Endocrinology, Jan., 2007). As long as you don’t eat within two or three hours of retiring, your thyroid medication should work fine and nothing else will interfere with it.

An alternative to that would be Tirosint. This liquid formulation is designed to be absorbed much better, without interference from breakfast beverages such as coffee or a latte (Pharmaceutics, Dec., 2013). You can learn more about thyroid treatment in our Guide to Thyroid Hormones."

peoplespharmacy.com/2010/08/26/taking-thyroid-medicine-properly/

[Maud04]

Good evening Adam10

I take my Levo in the middle of the night usually around3-4 am which means I can have my cup of tea when I get up in the morning around 6 -7 am

Kind regards

Maud

[Scouser58]

Hello Adam10,,,,I have always been told,,statins going to bed,,,and levo first thing,,,as soon as my eyes open,,which I have ready on my bedside table, with a drink,,,, I also prepare all my morning tablets into separate little pots,, ready to take down in the right order,,like this,,

1, levo,,,,then 30 mins or so later,,,2, bladder tablets,,,3, then prefood tablets,,,4, after food tablets of 4 different types,,, when I go to bed,,,then get up and get ready...then supplements come after the breakfast, and not before,,, so the 2-4 hour time frame is very un workable,,,,,good luck,,,ttfn from karen.

[helvella Administrator Thyroid UK]

As this is such a common question, I have just put up a new post. Nothing new there but pulls together the two polls and some research papers.

healthunlocked.com/thyroidu...

Anyone who flatly claims it must be taken in the morning would appear to either not have read any of the research, or to have some reason for dismissing it. Unfortunately that reason could be as simple as closed-mindedness.

[Eddie83]

Morning is impractical for many people. The rule of thumb I've heard (which I generally observe) is 1 hour before a meal, or 2 hours after a meal. When 2 hours is impractical, one hour will have to suffice; nobody can be perfect. Mary Shomon has publicized a study in which it was noted that coffee, especially, reduces absorption. It is sometimes helpful to employ a wristwatch, or smartphone, to alert yourself at appropriate times.