Quick question

[wowserclo]

Anyone know why I’m not meant to take magnesium at the same time (or within 4 hours) of thyroid meds? I need to take both in the eve so not sure what to do. (I take ndt which I need to take at intervals throughout the day.)

[helvella Administrator Thyroid UK]

wowserclo,

The main reason for keeping levothyroxine away from almost everything is simple - so many things interfere with levothyroxine and its absorption.

The amount of levothyroxine we take is tiny. So even a modest interference can make a difference. And most medicines do not have critical dosing.

For example, we are pretty used to 500 milligram tablets of paracetamol. It really wouldn't matter if we got a dose of 400 or 600 milligrams - quite possibly we'd never notice.

Whereas we have to go down to, say, 100 micrograms to get to a typical levothyroxine dose. If we get 95 or 105 micrograms it does really make a difference. (And 100 micrograms is just one five thousandth of the paracetamol.)

So anything that affects just a few micrograms of levothyroxine is important. This can be through directly binding to levothyroxine (iron, calcium, aluminium and magnesium compounds bind like that). Or substances that change the speed of movement through the gut - fast or slow. Or ones that affect acidity/alkalinity.

[wowserclo in reply to helvella]

Thankyou. Is this the same with NDT? I don’t take Levo x

[helvella Administrator Thyroid UK in reply to wowserclo]

wowserclo,

Yes and no.

We tend to read of the thyroid hormones in desiccated thyroid being bound to proteins. This could make quite a difference - but maybe it doesn't?

Trouble is, the only safe answer is to assume that desiccated thyroid does interact.

[wowserclo in reply to helvella]

Yes this seems wise. I will try and make more effort with my spacing! I think Im going to need a timetable!

[wowserclo in reply to helvella]

Ps thankyou for your lengthy reply. Most helpful to me! I’m finding it slightly difficult to take new medication spaced throughout the day without taking it near anything else!

[helvella Administrator Thyroid UK in reply to wowserclo]

It is difficult. I agree. I take levothyroxine, once a day, so it is very much easier for me. Sorry I don't have an easy, clear and simple answer.

[radd]

wowserclo,

Metal compounds ( magnesium, calcium, iron, etc) can reduce reduce the absorption of levothyroxine. Leave four hours between sups & thyroid meds.

[wowserclo in reply to radd]

Thankyou ! Is this the same with NDT I don’t take Levo anymore x

[radd in reply to wowserclo]

Yes .. All “medicated” thyroid hormones.

[SlowDragon Administrator in reply to wowserclo]

I have to take it less than 4 hours away

Taking T3 at 6am, noon and 6pm and Levo at bedtime

I choose to take magnesium about 3pm

It’s not perfect but it’s a compromise

[Heloise]

Hi wowser, I haven't called the companies but they only seem to recommend calcium and iron to be four hours apart from any thyroid hormone. Otherwise don't stress about it just keep whatever schedule you can manage and stay consistent....... then they will adjust your hormone dose accordingly.

[silverfox7]

I take my NDT all at once, kept forgetting the later dose so reading others did that I tried it and it worked for me. When you start NDT I think it's good to split as you then get more into you by the end of the day but your body has been hit with smaller amounts so not as much as a shock so I would give it a go then it's easier to get the loads of other things we take in the rest of the day.

Try at least to drop the dosing of NDT to two then once stable with that may be go for once.

[TSH110 in reply to silverfox7]

silverfox

I also found over time I no longer needed to split my dose of NDT it seemed to work just the same as two split doses plus I too was really bad for forgetting the second split dose. I wonder why the split dose is so important at first but not over time - perhaps it varies from person to person.

[humanbean in reply to TSH110]

Some people (e.g. me) suffer from fast heart rate and palpitations, sometimes even chest pain, when they take a whole day's dose of T3 or NDT in one go.

At one time (a few years ago) I was taking T3 in 5 miniscule doses. It's taken a long time, but I have now reduced it to 2 unequal-sized doses, and have managed to take the majority of my dose in the morning. When I first started taking T3 I couldn't take it first thing in the morning at all.

For me, I think the issue is cortisol-related. Mine was over the range in 3 out of 4 saliva samples when I first tested.

[TSH110 in reply to humanbean]

humanbean that is very interesting especially the cortisol connexion. I am sure mine is not right but I read stuff around it and could not see any path through it and gave up cos it did my head in.

I had terrible chest pains and palps when I first started on Levo and I was horribly overt -hallucinating, gone completely crazy, hideous nightmares and terrible chest pains plus a shed load of other things too horrible for words I was started on a measily 20mcg Levo which did save my life but they were very conservative in dose increase cos of those heart problems I wonder if they were too cautious given all the hyper surges I had already survived including the final mega dump of thyroid hormones (I wondered why I could suddenly run 10 miles effortlessly after being near comatose for months!) during decades of undiagnosed hypothyroidism. It took 9 months to get “optimised”

this being the worst phase of heart pains I ever had over the next two years on Levo.

I took the NDT swap very cautiously indeed for this reason. The pains gradually improved. But I had to split the dose or I did not feel well at all. I still get the pains now and again but it is a massive improvement. Why I could start taking it as one daily dose later on I don’t know. No one has ever suggested investigating my heart pains since I had ecg (abnormal) and stess test (abnormal but just something women get that is hormonal and nothing to worry about 😳🙄 John Radcliffe hospital) long before hypo diagnosis - which might be the hormone thing they mentioned 😬.

I have several relatives that have dropped dead of heart attacks on both side of family so when those pains come I think oh dear this could be it!

Perhaps I should have it investigated but it started in my 30’s so I will soon have lived as much time with it as without - you kinda get blasé.

Your heart must be so sensitive to changes in T3 you need smaller regular doses of NDT but interesting that it has become more tolerant of fewer larger doses, perhaps you had more success on the cortisol trail than I did and that has helped. I guess mine just likes to moan about it occasionally and must not be so sensitive to variations. I appreciate what a stalwart my old ticker is after all it has been through 😍

[humanbean in reply to TSH110]

I found that low iron was a huge factor in my chest pain. Improving that helped reduce the pain a lot. I don't just look at ferritin though, I always test serum iron, transferrin saturation, TIBC, and haemoglobin too, and since I can never get them all optimised at the same time I have to accept some compromises on the levels I achieve.

As soon as I let my serum iron fall too far I start getting chest pain again.

So, if you are still getting occasional chest pain, do a full iron panel and see what it shows you. It may be a red herring, but it would be worth checking to find out for sure.

[TSH110 in reply to humanbean]

humanbean Thanks for this info about iron . I get very breathless going up stairs despite being reasonably fit for my age and I heard that could be an iron problem. I have a pal who is really deficient she eats loads of ice which is a symptom. I was amazed to see a programme on the box about glaciers which are loaded with iron and little else - we have deep instincts as to what might help us not sure it explains my magnum addiction tho 🤪🍦

[silverfox7 in reply to TSH110]

T3 is quite powerful and so our bodies start with very low doses to get used to it so less lightly to be a problem if split. I didn't have any reaction so after a while made sure I was taking it twice a day then tried taking it all at one and had no adverse reactions.

[Ashanat]

You could consider using spray magnesium instead, that's how I got round the clash!

[Helsan]

I was finding it very difficult to space everything I take with T4 and T3. I spoke to the pharmacist and my endo and they both said one hour is fine for everything except iron which should be four. One hour for caffeine and dairy too.

[wowserclo in reply to Helsan]

Ahh I didn’t know that about iron! Thanks! I don’t eat dairy or drink caffeine anymore cos it’s bad for hashis so that’s something less to worry about thankyou

[EbonyEvans]

Have you tried different alarms on your phone and or stop watch / count downs. I do it when I need to up my water intake.

[wowserclo in reply to EbonyEvans]

Good shout!!