Newly diagnosed with a question

[Peppercat]

Hi there I was diagnosed with an underactive thyroid last week and have been put on 50 micrograms of Levothyroxine at the moment. I have soo many other health problems too one of which needs me to take a calcium and vitamin D supplement twice a day. This makes taking the Levothyroxine in the morning virtually impossible. My question is. .......... Is there any reason why I can't take my usual medication in the early evening and then take the Levothyroxine last thing at night as I get into bed????

[SlowDragon Administrator]

Many take on waking (as your GP may have suggested), but it can be more convenient and recent research, suggests perhaps is more effective taken at bedtime. Must be at least two hours after eating and 4 hours away from calcium and vit D

thyroxine must be taken on an empty stomach and then nothing apart from water for at least an hour after. (Especially no milk, coffee or tea)

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."

When you get your blood test in 6/8 weeks time to check progress, the advice on ALL thyroid tests, is to do early in morning, ideally before 9am. No food or drink beforehand (other than water)

If you are taking Levo, then don't take it in 24 hours before. So if normally taking at bedtime, delay and take straight after blood test. This way your tests are always consistent, and it will show highest TSH, and as this is mainly all the medics decide dose on, best idea is to keep result as high as possible

Do you know if you have high thyroid antibodies (Hashimoto's)? If not been tested ask GP to include at next test

There are two sorts TPO Ab and TG Ab. (Thyroid peroxidase and thyroglobulin) Both need checking, if either, or both are high this means autoimmune thyroid - called Hashimoto's the most common cause in UK of being hypo.

TPO is rarely checked and TG almost never checked. More common to have high TPO or high TPO and high TG, but negative TPO and raised TG is possible, though much rarer. There are a few members on here that have this, often they have struggled to get diagnosed.

[shaws Administrator]

Lots of people prefer taking a dose at bedtime and feel better than early morning.

As long as your stomach is empty and you allow 2.5 to 3 hours after eating before taking levo. When you are due a blood test you miss the night dose and take after blood test (stomach has to be empty too) and take bedtime dose as usual. You wont overdose as some people take a whole week's dose once weekly

[Marz]

Sorry this is not directly to do with your question Just wondering why you take Calcium and VitD ? VitD is known to improve the uptake of calcium from foods and as we know too much calcium is not good for us

Do you have your latest VitD test result ? How low were you ? Am thinking the 1600 IU's you are taking may not be enough .....

[Peppercat in reply to Marz]

I used to have an eating disorder and I now have osteoporosis.

I rarely eat or drink dairy products and up until last year was virtually housebound.

[Marz in reply to Peppercat]

I am sorry to read of your problems. If you can take a look at the link below you may read some helpful things about osteoporosis and its treatment. Calcium is involved in the breaking down of bone cells - not the building thereof. B12 is also involved in healthy bone marrow.

drmyhill.co.uk/wiki/Osteopo...

The above GP has written a wonderful book which I enjoyed - Sustainable Medicine. So much to read - so much to learn in order to be healthy

[greygoose]

Why do you need the calcium - if you don't mind me asking? Do you have osteoporosis? Or just vit D deficiency? Calcium isn't a very good thing to take, even when you really need it. It's much better to get it from food, if you can. And, taking vit D3 will increase your absorption of calcium from food. But, if you're taking Adcal - which is what it sounds like - there isn't really enough vit D3 in it. In any case, whether you're taking vit D3 and/or calcium, you should be taking some vit K2-MK7 with it, to make sure the calcium goes into the bones and teeth, and not the soft tissues, like the heart and kidneys.

If you are taking calcium and/or vit D3, you need to leave at least 4 hours between it and your thyroid hormone.

[Marz in reply to greygoose]

[Peppercat in reply to greygoose]

@greygoose see reply above

[greygoose in reply to Peppercat]

OK, I see. But, it's not just dairy that contains calcium. A lot of veggies contain calcium, and other things.

Besides, we've all been brain-washed to believe that bones are entirely made of calcium. They aren't. They need a range of other nutrients, like magnesium and zinc, vit A, etc. Concentrating on the calcium, and stuffing patients with calcium supplements, is one of the big mistakes that doctors make. Magnesium is even more important for bones than calcium. Do you take magnesium? Most people are deficient in it, because soils are depleted. I think you really ought to do a bit of your own research on this.

But, how is your vit D, anyway? Is it low? If so, you're probably not taking enough to bring it up. And, have you had your vit B12, folate and ferritin tested? They could be low, too. And they need to be optimal.

[Peppercat in reply to greygoose]

I haven't had any vitamin checks since I beat the eating disorder 6/7 years ago tbh!!!

[greygoose in reply to Peppercat]

lol OK! Well, things have probably changed a bit, since then! Best to get them done again, if you can.

[Hidden]

i have to take calcium supplements after thyroid surgery.

its temporary.i take levo everyday at 7 o clock i have my coffee after one and a half hour and after two hrs i take calcium.dont take calcium the same time as you take levothyroxine.

doctors said to me that it should be take in the morning on empty stomach then wait for 45 minutes before drink or eat anything.i wait more thann an hr.]

calcium is also really important.my opinion is that you should take your thyroxine in the morning because your body needs it to go through the day.and its the best thing .at the evening is not good at my opinion.

[greygoose in reply to Hidden]

Actually, it's very good to take levo in the evening, it's better absorbed. You don't need it to go through the day, because it's an inactive storage hormone. You could just take it once a week, if you liked. And, you really should leave 4 hours between your levo and the calcium, or the levo will bind to the calcium, and you won't get much benefit from either.

[Hidden in reply to greygoose]

4 hours? thanks from tomorrow i will check this up...

[bantam12]

Were your parathyroids removed as well ? If not then as the others have said you need to be careful taking calcium.

[Hidden in reply to bantam12]

how will she know if parathyroids were removed?

[bantam12]

If all 4 parathyroids were removed, which shouldn't happen, then a person would have hypoparathyroidism and would rely on taking calcium. Rarely during thyroid surgery 1 or more parathyroids may be removed or damaged but as long as 1 or part of 1 remains function can be maintained. Pathology report should state if any parathyroid tissue was attached to the thyroid that was removed.

[Peggles]

Thanks for this. I was really confused about how to take my calcium uptake pill with levothyroxine too (I have PMR and am on steroids so need to offset the harm they do). Today I took it at 4am but can now take it at bedtime.