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Thyroid UK
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Best time to take Levothyroxine?

With a TSH of 9.9 and a T4 of around 10 my GP finally prescribed 25mg trial of Levothyroxine and will retest in 6 weeks. The instructions say to take in morning at least 30mins before food.

This is doable I suppose as I normally wake up at 6am get ready and have my porridge about 6:30 so it will be tight but there or thereabouts.

Is this ideal though? my other meals are about 12:30 and 8:30 at night - is there a better time to take this?

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hankypm

Despite what the patient information leaflet says, patient experience tells us that for best absorption levo should be taken on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for one hour each side. Also, levo should be taken 2 hours from any other medication and supplements (some need 4 hours, some need opposite end of the day).

So you need to find a time that fits in with that. For me, because I regularly get up during the night for a bathroom trip, I put mine on a small tray on my bedside cabinet with a glass of water and take mine any time around 3-6am.

If it suits you better you can take it at bedtime, following the advice above, but if you have your main meal in the evening then leave 3 hours after eating before taking Levo.

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Hmmm, tricky to find a good time for me. maybe mid-afternoon is best as this is the longest I am without food. Waking up in the middle of the night is not going to suit me!

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"So you need to find a time that fits in with that. For me, because I regularly get up during the night for a bathroom trip, I put mine on a small tray on my bedside cabinet with a glass of water and take mine any time around 3-6am"

Susie, that's exactly what I do! In fact was thinking of asking the folk here if it was OK, so you saved me the bother. My sleep pattern has been very irregular for several years (though eventually seem to get enough sleep overall) I have settled on any time after 3 am, if I wake up that early, and not later than around 7 (which usually means not getting back to sleep but having to wait a couple of hours for that first cuppa

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It's best to leave an hour before eating or drinking anything other than water after taking levothyroxine. NHS latest advice is to leave 4 hours before eating calcium rich food. Many people take levothyroxine at night time, leaving at least 2 hours after eating or drinking except for water. Ensure that you leave 4 hours after taking levothyroxine before taking any other medicines or supplements.

Starting dose of levothyroxine is 50mcg unless very young, very old, infirm or with a heart condition. Unless you fulfill the categories mentioned, ask your GP for a dose increase. 25mcg will knock out existing thyroid function and not replace enough so you are likely to feel more unwell. A TSH of 9 is high considering most people don't feel well until their TSH is around 1 or a little lower. Retest bloods 6 weeks after starting levothyroxine and increase and repeat again in 6 weeks and so on until your symptoms abate or your TSH is around 1.

If you reach your optimum dose of levothyroxine and still feel unwell then it could be low vitamin levels which are common in people with thyroid disease. Thyroid hormone will not work well until vitamin levels are optimal, not just anywhere in NHS range. Ask GP to test the following:

Vitamin D

Folate

Ferritin

Vitamin B12

Thyroid antibodies TPO and TgAb

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I did ask why 25mg and not 50mg and she said that as I am only slightly hypothyroid then I don't need a big dose. To be honest she did not appear to be clued up on this. She did question why my TSH had jumped from 6.1 to 9.9 in just 2 weeks and I said that with the Medichecks test I did it a fair bit earlier in the day and fasted - she said that would make no difference at all.

At least I am being treated. the pharmacist questioned why I had top pay though and said I should be exempt. but I guess as it is only a trial then I don't qualify.

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Well, you should qualify for a medical exemption certificate because you are hypothyroid. Your thyroid is failing and it's not going to suddenly get better. If you have thyroid antibodies it might fluctuate but in the end it's failing and will get worse. TSH does vary at different times of the day. It will be higher in the morning and lower later in the day.

Are you symptomatic?

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Very symptomatic, too many to list but mainly low temp. 35.8, brain fog and digestive issues. I have no antibodies though.

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Bed time is the best for me by a mile.

It ties in as well with our natural cycle as we make thyroid hormone when we go to sleep. I take it at bedtime, but you can take it in the evening as well.

Some people have an issue with absorption and so find it is best to take it away from food, but lots don't have this issue so don't get too worried about taking it near food.

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hankpym Which antibodies have you had tested and which vitamin levels?

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The 2 that Medichecks test. Difficult to tell with the vitamins as I was low last year on iron, Vit D, B12, but I supplement heavily now and not tested for awhile. Ferritin has been measured twice and continues to stay around 65 ug/L the iron tablets don't seem to bring that up.

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Have you ever had an ultrasound of your thyroid gland or have you got any swelling in your neck? Some people have Hashimotos without antibodies apparently but there would be some indication of thyroid disease in an ultrasound but some people simply have a struggling thyroid without antibodies present.

The fact that your vitamin levels are so low and not shifting much with supplements makes me wonder whether you have some kind of absorption problem. Have you excluded pernicious anaemia and coeliac disease? Could you ask your doctor to exclude these 2 autoimmune conditions? It could contribute to a struggling thyroid or at least to symptoms.

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Yes I would not be surprised if I have absorption problems. I have quite pronounced digestive issues, I have had a stomach probe but nothing was revealed there. I have to take Omezaprazole as I get terrible acid reflux and have for years. I have cut down to 2 or 3 tablets a week now which keeps it under control. I also have motility issues as well, bloating, constant belching, it dies down every 2 weeks or so but always returns.

If there is a reliable coeliac/gluten intolerance test maybe I should take one of those.

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If you've had gut investigations that haven't revealed any problem, it could be that your gut bacteria is imbalanced rather than an autoimmune condition causing the problems. This will disturb thyroid function and ultimately brain function too because your vagus nerve connects your gut, thyroid and brain.

There are some things you can do to improve the situation. Taking Kefir everyday will increase good gut bacteria. 170mls daily will give you about 30% of your daily calcium requirement along with phospherous and numerous other vitamins. In addition, Kefir contains over 30 good bacteria strains compared with about 10 in yoghurt. You can repopulate your gut by taking Kefir. It will take a few months to begin to make a difference. You can also research and buy good probiotic supplements if you can't take Kefir. Fermented foods will also help. Naturally fermented saurkraut is said to be good as well.

According to NICE, PPI's contribute to osteoporosis so it's critical to ensure great calcium intake in the food you eat. If you get your gut bacteria working well you should be able to decrease PPI use and eventually wean off them with the help of your GP. You could also benefit from going gluten free even if you don't have coeliac disease. Wheat is ripened with glyphosate and so most wheat contain some chemical residue and can irritate our digestive systems. Also, I read that modern wheat has been modified by selection to contain much more gluten than our forebears ate so it's possible that we simply cannot process so much gluten.

I would give all these modifications to your nutrition a go because it could improve the quality of your life and if it doesn't, it won't do you any harm. Do not, buy and eat factory produced gluten free products but rather simply buy fresh food, organic dairy, meats, veg and fruit and enjoy eating them. You can eat some buckwheat, sweet potato and starchy veg to give you some carbs and eat a varied diet of foods. Including fish with the bones such as tinned sardines or tinned salmon will improve calcium intake.

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I have tried many times with probiotics of various kinds with no real success.

I am not sure how a gluten free diet is even possible for a family man like myself - it would disrupt the whole families mealtimes and would definitely be a case of the cure being worse than the cause. I Cannot possibly see how that can work in practice - me making my own meals while everyone sits round eating theirs.

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Most fresh food Is gf. I personally avoid the gf section in the supermarket as I don’t like the taste of it but lots of people live quite happily by substituting. It’s a lot easier than you think to opt out and the benefit for me have been enormous. Only thing I would say is do it or don’t. It’s not a halfway thing. Good luck

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I really don’t see how it is possible in my circumstances though. My family like to eat stews, pasta in the week and pizza and curry at weekends I would not want to disrupt what is valuable family time by making everyone change diet to suit me. Would cutting down on gluten have any beneficial effect or is it really all or nothing?

I go to the in-laws this weekend, I could not imagine the fuss if I imposed restrictions on what they can serve!

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It’s entirely up to you weather or not to do it. But have a look at the supermarket shelves of free from before you decide. As for stews wow we love stew. No gluten there. It can sound daunting but it’s not hard. Whatever you do good luck to you in the future.ps my partner and rest of family are not gf.x

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You could be doing your whole family a favour by going gluten free as you will reduce the chemical load on their gut. I use a 3 tier steamer and cook 3 tiers of veg, put rice in the top, fish on the bottom. A whole meal done in 30 mins. You can get gluten free pizza Base. A slow cooker does lovely stews. It's really not a problem to cut out wheat and barley. You can buy gluten free gravy granules or make your own. The benefits are worth it.

Substitute buckwheat noodles or buckwheat pasta for wheat pasta. It tastes delicious.

Curry, no problem, use fresh spices and fry in clarified butter and add meat and fresh ingredients. You can thicken sauces with cornstarch.

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I've been gluten free for several years now. When I visit my family I find they have changed to gluten free pasta. You can buy gluten free pizzas to put in the freezer.

Stews are not a probably as you can use gluten free flour for thickening. I use Knots stock cubes or gel sachets as they are all gluten free. Your family will not notice the difference. You can keep your own supply of GF bread and cereal.

My grandaughters actually prefer the gf porridge to the usual sort.

Your health is worth it and your family will think so too. Good luck!

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Oops that was Knorr stock cubes!

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Would reducing gluten not help at all? obviously cutting out completely would be the way to go but in reality in my situation that would not work.

Surely a big reduction would have some benefit?

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Cook real food, don't eat cereal or bread or pizza or junk (eg cake). That covers most of it and your whole family will be healthier. They can eat sandwiches and breakfast cereal if they must.

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Did you check with the pharmacist about taking Omeprazole? Apparently hypothyroidism causes lowered stomach acid. I have some reflux (not that severe) and gave up the Omeprazole (didn't need them that often). An occasional Gaviscon tablet (1-2 a day instead of the former 3-6 plus 1-3 Omeprazole a week) seems to be enough to keep discomfort at bay

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Gaviscon does nothing for me. Zantac works but nothing like omeprazole - it makes meals out and holidays enjoyable again. I don’t take it often 2 a week or 3 if I have a meal out.

Hopefully the Levo will assist and enable me to wean myself off them.

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let's hope so x

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Hmm, thyroid hormone replacement doesn't work like that and you are definitely hypo, not just a little and were when your TSH passed 3. I would point out to your doctor that she is not following NHS guidelines, you should get a blood test (first thing in the am and fasting, regardless of what doctor says) after 6 weeks and an increase of 25mcg until TSH is under 1 and free t4 (and free T3) are in the top quarters of their ranges. I don't think your doctor sounds very knowledgeable.

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Hi I noticed you guys are discussing PPIs..I refuse to take them and I'm currently having issues with acid reflux, trapped wind so bad it's messing around with my heart etc. I suggested because I'm newly diagnosed hypothyroid..maybe I have low stomach acid..since that can cause the reflux, and of course low t3/4 can cause your upper and lower oesophageal sphincters to not function as they should. Consultant says nope..but given my hypothyroidism seems to be causing me issues everywhere, including my guts..I wosnt be surprised. Will be having another endoscopy soon along with pH studies...ranitadine often brings on the acid reflux..if anyone has had similar issues? I bloat loads too...just thought I'd get involved in the conversion:)

Thanks

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I would check with the pharmacist on the best solution. Maybe a very low PPI would help until you heal - it sounds like a case of balancing out the risks. Without them you are very unwell and at risk. With them you have less risk of serious heart issues or even worse oesophageal damage, but other digestive problems might be worse, and you would find it harder to absorb thyroxine.

Why not start a new thread on this, more likely to get advice from those who know more than me.

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Hey, thanks :) I think I'm gonna wait it out and see what the studies suggest. Thanks

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Michaela_l and hankpym

Most medics still deny low stomach acid exists as they can't test for it and there's no pharmaceutical treatment

(Sounds just like mainstream medics refusal to acknowledge antibodies and gluten connection with Hashimoto's!)

Being hypothyroid, (especially if have Hashimoto's) then low stomach acid is more common problem than high acid

Same or very similar symptoms......but very different treatment

Low stomach acid can be an issue

thyroidpharmacist.com/artic...

drmyhill.co.uk/wiki/hypochl...

scdlifestyle.com/2012/03/3-...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

pulsetoday.co.uk/clinical/m...

gov.uk/drug-safety-update/p...

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Yes, it's common to have gut dysfunction with thyroid disease. Do you have thyroid antibodies? You could try a teaspoon of apple cider vinegar in a glass of water before each meal, but start with taking once a day to begin with, see if it helps.

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I do apple cider vinegar in a big glass of warm water every morning before breakfast. Believe me after suffering with gut issues for 10 years I have tried Everything! apart from of course an extended gluten free diet.

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If you have antibodies try gluten free.

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Gluten intolerance is often an underlying issue

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