Night shifts

[Chloecaff]

Hello, so since I started taking my thyroxin in May, I’ve found I struggle more during night shifts, especially sleeping the day after. The only think I can think may be that I take my tablets at the same time everyday( in a morning ) so after a night shift I’m taking it as I finish then going to bed (still making sure I havnt ate for a few hours before I take it) where as obviously the rest of time time I take them upon waking up,

Do you think if I stopped taking my tablets as I get home from a night shift (before I go straight to sleep), and take them when I wake up it could possibly help me sleep ? Then once my night shifts are finished as there’s never more than 3 in a row just go back to taking them in a morning?

[marsaday]

Lots of people do better taking t4 at bedtime. So for you that is your morning.

I take mine at 10-11pm when I go to bed.

[Chloecaff in reply to marsaday]

I sleep great through the nights, it’s only when I’m on night, so sleeping through the day that I really struggle so wondering if I should just take my tablets once I wake up from nights rather than as soon as I get home from work

[marsaday in reply to Chloecaff]

Try messing with the times. It has a big impact on how the T4 works. Most people stick to morning dosing, but if they experiment they can find a different time works much better for them.

[MaisieGray in reply to marsaday]

marsaday I don't think that bedtime/sleeping per se, is the issue that impacts on the benefits (where they exist - not every study has resulted in positives, I believe) of nighttime dosing. The Dutch study found that compared with morning intake, direct treatment effects when levothyroxine was taken at bedtime were a decrease in thyrotropin level of 1.25 mIU/L; an increase in free thyroxine level of 0.07 ng/dL, and an increase in total triiodothyronine level of 6.5 ng/dL. Secondary outcomes, including quality-of-life questionnaires etc, showed no significant changes between morning vs nighttime intake of Levothyroxine. The researchers posited how the bioavailability effects of levothyroxine could be explained: "An interval of 30 minutes between taking levothyroxine and eating breakfast may be too short to prevent interference with gastrointestinal absorption of levothyroxine. Moreover, many patients drink coffee in the morning, often instead of eating breakfast, or may take other medications that interfere with levothyroxine absorption. In contrast, most patients in our study stated that they had eaten no food or snacks for several hours before bedtime, this being their usual routine. Bowel motility is slower at night, resulting in more prolonged exposure of levothyroxine to the intestinal wall and, consequently, in better bioavailability. Furthermore, basal gastric acid secretion is highest in the late evening and is lowest in the morning. An acidic environment promotes the absorption of levothyroxine. These circadian differences in gastrointestinal function could be a pathophysiological explanation for our findings."

[marsaday in reply to MaisieGray]

I don’t get what you are trying to say to me and the poster. You quote some info from a study and this is not explained well at all. It is typical doctor speak which aims to bamboozle the patient instead of help guide.

What are you trying to say here?

Yes try a different time or not?

Nighttime dosing is more effective for me because I think it fits in better with our natural thyroid hormone production.

The poster is asking about trying different times and I say go for it.

[MaisieGray in reply to marsaday]

marsaday I too sometimes/often find scientific documents way above my intellectual paygrade; but shared about the Dutch study here because it seemed to me to be presented in clear everyday lay person's language. I'm sorry if it didn't come over in that way to you. The point being made in the last sentence (in bold) is that any improvement in nighttime dosing over daytime dosing, could in part, be down to the natural differences that arise in gut function throughout each cyclical 24 hr period - for instance, the fact that gastric acid, important for absorption of Levo, is higher in the late evening; and that the movement of food through the GI tract and therefore of any orally-administered drugs, is slower therefore making it more bio-available. These things happen independent of being awake or asleep and therefore of nightshift workers sleeping at opposite ends of the day from those not working at night.

[MaisieGray]

Chloecaff I think one of the problems may be the very fact of you being a shift worker, which is known to have a deleterious effect on our health. A study found that shift working could be a precipitating factor in the development of hyperthyroidism, for instance. Regarding hypothyroidism though, a study from 2011-2015 by Moon et al showed that night shift workers had TSH levels that were higher than the levels of non-night shift workers, and that night shift workers exhibited a 1.399 fold higher risk of subclinical hypothyroidism than their non-nighttime workers. An earlier study found that subclinical autoimmune hypothyroidism was twice as prevalent in shift workers as non-shift workers. So whilst none of that gives you a solution to your problem, it might help to understand that the fact of working night is a stress factor that can have a very direct affect on your thyroid health. It is definitely not recommended to swap your timing of your Levo as you suggest; but perhaps you might benefit from changing to night time dosing and see how that might improve things - given the findings above, that nighttime workers have higher TSH levels for instance, it certainly isn't contraindicated.

[SilverAvocado in reply to MaisieGray]

I was thinking the same thing as MaisieGray, night working is always damaging to the body, and its just the kind of thing that's more difficult when hypothyroid.

A personal experience I've had, that may or may not be relevant. As I increased my hormone replacement over time, and overall felt better, I found different symptoms would pop up and become more pronounced. The way I made sense of it was to think that when I was seriously unwell, I felt terrible, tired, and in pain all the time. But then as I felt overall better, I'd notice if some activities gave me back pain or stopped me from sleeping, because it was more of a contrast.