Some advice needed taking levo on an empty stomach! Really worried


I was hoping that someone could please give me some advice. I am really worried as I'm due to have a blood test from my doctor next week and this mirning (by accident) I took my levo with water that had bits of orange floating in it (my husband didn't wash my glass out last night before he brought my glass u :() So basically I had half a glass of water with horrible floating pieces of orange in it before I realised something was off. Can anyone tell me if thus breaks the empty stomach rule for taking levo? Will it affect absorption? I am so worried that this will interfere with my blood test. Thanks to anyone who replies x

19 Replies

  • I don't think it makes any difference, the small volume of orange will not cover much of the gut or have an effect on stomach acidity. Coffee is the only food substance that I know of which has a big effect on absorption.

    Even if you absorbed none of today's levothyroxine it would have virtually no effect on your blood hormone levels. Due to the long half life of thyroxine we store more than 10 days worth of thyroxine in our blood (sorry can't be precise, I can no longer do the maths). So even if you skipped today's dose the effect on your blood test next week would be less than a few percent, well within the accuracy of the test.

  • Hi jimh111, thanks very much for your helpful reply. That is really reassuring. I was worried as I don't want anything to interfere with my blood test next week. I do drink coffee, although wait 2 hours before my first cup in the morning.

    I had no idea that if I missed a day of levothyroxine that it wouldn't affect my blood levels. That is a good bit of information to know! I don't have any food or drink the morning of my blood test and I take my levo afterwards, but do you know if it would be okay to drink a glass of water before heading to the doctor for the test? Thanks again for your kind response!

  • I wouldn't take thyroid hormone within a few hours of a blood test as they can give misleading results whilst they are being absorbed and bind to proteins. If my blood test is after mid-day I take my levothyroxine and liothyronine in the morning. I always have my breakfast before a blood test, I'm not having someone sticking a needle in me whilst I'm starving! I think the idea of skipping food and drink before a blood test is that the TSH might be a bit higher and you get a bigger prescription. I'm not sure this works and I'm not in favour of fiddling blood tests. You want to know what your hormone levels are during a typical day, so don't change your routine.

    Coffee has a big effect on levothyroxine absorption if taken within an hour of taking the tablets. If anyone needs (or wants) a morning coffee simply switch to taking levothyroxine at bedtime.

  • I need my morning coffee but am careful to take it 2 hours after my levo! I tried to give it up without success... Thanks for the info. I'm dreading next week a bit less now!

  • It is good to be hydrated with water before a blood test as it helps with the blood flow.

    Jo xx

  • Hi Jo, thanks for the tip! My doctor actually has trouble getting blood from me. He actually had to give up last timw which is why I'm going back next week. I was eally cold at the time, so will wear a jumper and jacket this time and drink lots of water!

  • The nurse has struggled with mine too and one of them filled a rubber glove with warm water and held it to my inner elbow and the blood just flowed. Quite a good tip.

    Jo xx

  • hi Jo, thanks for the tip. My blood test is tomorrow and I appreciate the advice- will give this a try with a hot water bottle before i leave xx

  • Hi again jimh111, I was just wondering if I could ask your advice? My last blood test 6 months ago showed a TSH of 1.2 (the lab won't test for t4 for some reason). If this time it comes back higher (say over 2) should I request more levo? I felt ok when it was 1.2 but lately have been feeling tired.

  • Yes. Your levothyroxine should be titrated based on your clinical response and blood tests, with more emphasis on how you are than the numbers.

  • thanks!

  • It's not ideal but it probably will have an insignificant effect. One day taking your Levo "wrong" isn't the end of the world. Levo is a storage hormone it stays in your body for a good week and gets used when you need it. Your blood test is next week, your fine. Don't worry about it ;)

  • hi dang, I never knew that! It is helpful to know in case I ever did miss a dose by accident. I was so worried about my blood test getting messed up (this is my first 6 month TSH check after going on 100mcg of levo) and didn't want anything to interfere with it. Last time the doctor took a blood test my TSH was 1.2. I was wondering if I could ask what I should do if my TSH comes back over that number, if it's 3 or something? Should I request a higher dosage? I feel best when it's around 1 but lately have been a bit sluggish

  • Yes however please do make sure you take it every day, just because it won't be super harmful to miss it once doesn't mean it won't add up if you often forget to take your dose :)

    I understand your worry about blood results getting messed up, I go through that every time I have a test and follow up (just had a follow up this morning) all I can say is do your best, and while it's good to be informed, don't get too stressed about it, we're all still learning and we all make mistakes, but stress of any kind is bad for health and thyroid in general.

    If your TSH goes up a (qualified) doctor should raise your dose to bring it around one. Some doctors can be completely clueless about TSH while others well informed, if this happens I would recommend telling your doctor how you feel and that you think you'd do better with your TSH lowered from your own experiences. If the doctor refuses for any reason find another doctor who knows what they're doing.

    On a similar note, have you had your FT3 and FT4 tested? If you have those results it could reveal more, for example you could have a TSH of 1 but low T3 and still feel sluggish.

  • Hi dang, thanks foryour reply. Yes I do get stressed about it. It's only my first check since I started 100mcg in August last year. I definitely get stressed, and agree that stress is bad for your thyroid.

    If my TSH has gone up I will request that it is brought down to around 1, as I definitely felt better when it was that low.

    As for the FT3 and FT4, the lab apparently won't test for FT3, and also won't test your FT4 unless your TSH is high! Tried asking the doctor about this but he said that was how they did it :(

  • sorry, meant to say last time I had FT4 tested it was 14 (I think).. it was a while ago! I would love to know what it is now

  • Ah ok. Here's my advice, and it's the advice I need to give to myself too since I tend to focus really hard on numbers and results.

    So TSH alone is a tiny factor here, there's a chance your TSH is fine and you might get more frustrated getting this result yet still feeling not so great. So what is sooooo important is your diet, your nutrients, resolving any deficiencies you might have. These things have an effect on how your body functions and how well it converts your Levo to T3 for your body to use.

    So just be prepared, it might not be your TSH, that reading alone gives us little info about your actually thyroid health. Have you have your B12, D3, ferritin, folate checked? How about a regular blood panel? This can often gives us waaaaay more info about how someone is doing and how we can correct certain symptoms.

    As for the FT4 test, that's unfortunate, I personally had a good TSH but felt lousy, I had to finally demand FT3 and FT4 tests, the results showed I was over range in FT4, when they reduced my dose my TSH went up and FT4 didn't budge, this is how they realized I need T3 and not just Levo. Maybe you could find another doc willing to do this test? I'm sorry I don't live in the UK (as most members here) so I don't know the difficulties involved in getting this testing done. I know some members order private tests, pay for them, then present these to their doctors. You might want to search on the forum for this.

  • hi dang. thanks very much for your kind and helpful reply. I wish the lab would do T3 anf FT4. As far as i'm aware, they have never done T3 tests for anyone. Seems weird, but anyway.... The doctor told me that the lab only tests T4 is your TSH is out of range?! Said there was nothing he could do about it. That is interesting about you needing T3- I can see why it is important to get T3 and T4 tested now. I am glad you feel better ow on T3. They are very unwilling to test T3 here- it seems odd. As for other tests, my doctor is going to do ferratin, B12, vit D, etc tomorrow.

    I am having trouble losing weight despite a good diet... maybe these tests will give me some clue as to why that is...thanks!

  • It's good that you can get your vitamins tested, people who are hypo often have deficiencies, and sorting these out will go a long way. It would be a good idea to post these results on the forum and see what some of the more senior members have to say. Even if your doctor says it's "fine" or within range, that's often not good enough for people with thyroid issues.

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