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Thyroid UK
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Really need help

Hi all , I take 75mg of thyroxine , 20 mg of fluoxetine and 1000mg Vit D , trouble I have is I’m addicted to coffee and I’m up for work at 4:30 am so I really need a coffee to get myself functioning at that hour , but I also know caffeine effects absorption of thyroxine so what can I do ? Some times I think I could take my thyroxine at night but when do I take my other meds ? And also I forget to take it so plus I’m finding I can sleep for 17 hours some days which is concerning , I have thalassimia trait so should take iron and also going through menopause at 47 but being a smoker I’m not allowed any meds for this reason so feel like I’m all alone to deal and find answers .

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The fluoextine could actually also affect the absorption of levothyroxine too

Your dose is pretty low and smoking is actually the last thing you should be doing

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One thing I detest is people who think they have the right to judge others , exactly what you did in your response !

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Sorry but it is true that smoking and thyroid are not good

Not a question of judging you

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Eliana, I think that reallyfedup was trying to help you rather than judging you.

I stopped smoking in June 2018 using champix and only following this did my blood results show a definite diagnosis of hypothyroidism. I believe the smoking reduced my TSH enough to keep me within ‘normal range’.

I also feel that I probably don’t need my citalopram however I will consider that when I am optimally treated with my thyroid.

I too set an alarm for a couple of hours before I need to get up to take my thyroxine. I almost do it in my sleep because have no problems going back to sleep.

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Really pleased for you , but I came on hear for advise , I really wish I hadn’t to be honest , I appreciate your reply but I do not like people who preach to people they no nothing about , every one is different , and has a different response to treatment , people are quick to blame smoking

for lots of things but strictly speaking no one really knows , I gave up smoking when I found out I was pregnant I ate healthy and did every thing by the book , didn’t stop my late miscarriage at 7 months , my mother never smoked or drank , died of multiple blood clots to the heart , brain and lungs (63) my Aunty never smoked or drank died from cancer 2 weeks later her sister died from a massive stroke in her sleep , never drank never smoke , within 2 weeks to aunts dead so can you see why it hit a raw nerve , people are quick to judge when they know nothing about you . Thank you Redrosegirlie , I appreciate your response , but will seek advice else where .

Happy new year to you .

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Really sorry to hear you had a late miscarriage, I hope you had support at the time. Doctors often underestimate the long term physical and psychological effects on a woman of this ( I know from experience). I take my Levothyroxine at 5am and then go back to sleep, I’m a tea addict and can’t get up and walk my dog without a cuppa.

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I'm very sorry about your late miscarriage (I had a couple of early ones).

You pose some very serious issues which are philosophic and ethical more than purely medical, basically "Why do bad things happen to good people?", for which I cannot give you an answer.

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I agree I have never smoked so don't preach. Nether of my sisters or nieces smoke either, however we all have many different health problems even with healthy diets, it's all in the genes, maybe. Good Luck.

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Hi, with the family history yo7 mentioned, have you been tested for any blood clotting disorders? There is a lot of stroke history in my family and I was tested and find to have prothrombin gene mutation and Factor V Leiden.

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It's extremely common for hypothyroidism (especially Hashimoto's) to be "revealed" after stopping smoking

Tobacco seems to suppress thyroid antibodies

We see some people turn up here after giving up smoking with extremely high TSH

GP's are supposed to offer more frequent thyroud testing for 2 years after quitting smoking

Research going on into analysis of substances in tobacco using these for antibodies suppression in Hashimoto's patients

thyroidpharmacist.com/artic...

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SlowDragon, I didn’t know about the thyroid testing after giving up smoking! December 2017 I had a TSH of 2.9 taken at 4pm whilst being a smoker. I was extremely symptomatic of hypothyroidism with my central heating permanently set at 24 degrees. I really think in different circumstances that TSH would have been higher.

Interesting too about the research. Thanks.

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I never knew about stopping smoking and Elevated TSH but on looking back at my bloods your right, who would have thought,

13/1/00 T4 89 (55-144)

TSH 4-7 (0.4-4-5)

Stopped smoking April 2000

12/10/00 T4 47

TSH 45

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I didn't go hypo until after I stopped smoking - I think sometimes it keeps you going and suppresses your appetite (not good for you, but can mask symptoms). Both coffee and fluoextine will stop levo being absorbed well. I'd take levo last thing at night before going to sleep and everything else during the day. You can buy your own ferrous fumarate without a prescription in the same strength as you'd get from GP. Why does smoking stop you from getting meds?

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I can’t have HRT as I smoke and makes the risk of having a stroke higher yet with out it I risk osteoporosis so can’t win either way

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You could try buying your own progesterone cream online and also some of the different herbal remedies. Which ones are most likely to work depends on the individual - there used to be a site called something like Know your menopause type with a useful questionnaire. So do a web search for it and see what you can find. The non-bioidentical HRT that most GPs give you is very nasty stuff and you don't want it.

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I set my alarm for 2 hours before I want to get out of bed. Have water and meds beside the bed and take them then straight back to sleep for 2 hours this way it doesn't affect anything. 😎

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Thank you for the reply .

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Do you have any recent blood test results and ranges you can add?

75mcg is a low dose of Levothyroxine.

Depression is common symptom of being hypothyroid and therefore still not on high enough dose of Levothyroxine

Dose should be increased slowly in 25mcg steps until TSH is between 0.4-1.5 and FT4 in top third of range

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

All thyroid blood tests should ideally be done as early as possible in morning and fasting. Do not take Levothyroxine dose in the 24 hours prior to test, delay and take immediately after blood draw. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you do your tests?

Essential to take Levo EVERYDAY

Many find it easier to take at bedtime

There's a strong link between smoking and autoimmune thyroid disease also called Hashimoto's. Many of us are smokers or ex-smokers.

verywellhealth.com/cigarett...

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Rather than wake up earlier (as you’re already getting up really early) you could take all your meds except Levo when you wake, along with your coffee and then take your Levo before you go to sleep. I keep my meds by my bed so I remember and there’s a routine of taking on waking and when going to sleep.

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Hi Eliana,

Like you I have to have my coffee in the morning otherwise I just don't feel human and taking my thyroid meds was always a problem. About 4 months ago I started taking them at night just before I go to bed -- they're on my bedside table to make it even easier. I can't tell you how much better I fee as a result. I also seem to remember that there was a thread on here that recommended taking the meds at night.

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It can be a real hassle fitting everything in far enough away from everything else.

This might be a controversial suggestion but I have heard of people taking their entire weekly dose of Levo all at the one time. You could take it one morning or evening and only need to have everything perfect (on an empty stomach, nothing for an hour afterwards, etc.) once a week.

Also, Vit D could be taken over two or three days rather than every day.

When I took Levo I took it at night just before I took my glasses off and went to bed.I think you have to use other things you do every day to get into the routine of taking it.

Would you consider taking decaff coffee some of the time? I started taking decaff in the afternoon, now I take it all the time. Even one a day might help. (I know there's still some caffeine in it but it's not enough to give me migraines like ordinary coffee.)

Smoking - I worry about my son. I think smoking is masking his thyroid problems but that's his - and your - choice to make.

Hope you manage to find some solutions.

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I have my levo on my bedside table and take it before bed. Works very well for me. Means I can easily not eat or drink anything for 2 hours beforehand and take vits and eat what I want in the morning.

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Hi Eliana

A nurse once told me that nicotine can be at least as addictive as heroin, in spite of the fact that some people seem to give up with comparative ease.

So please try not to think anyone is "Judging" you. The advice to give up smoking is out of concern, not criticism. For your own sake, you need to give up if you possibly can. Hypothyroidism makes life difficult enough without that added burden.

Two good friends of mine (one was under 60) died from the effects of COPD, caused by smoking, and another friend also has it, though still coping well so far. Two cousins died from lung cancer as a result of heavy smoking. All of them gave up, but the damage was already done.

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Jnetti, I think research has proven cigarettes are harder to give up than heroin and that the withdrawal symptoms can be worse.

Frightening really.

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It is frightening. I am so grateful that I never started smoking. Having asthma as a child helped. So did my grandfather who lived with us and smoked a smelly pipe using twist tobacco!

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Didnt know coffe and thyro meds interaction. Are they real? Coffe is one of the substance that really dont harm your body. In fact multiple studies shows benefits for health much more than cons. About smoke it is also a fact that is kind of an anxiolytic. Psychiatrist would tell you that in certain amounts for a smoker is better not to quit in some circumstances but rather reduce your dose specially if you are under lot of stress.

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I didn't realise it either, until reading on here. Anything with calcium (cheese, eggs, milk, yoghurt…) does too. It seems that iron supplements can't be taken with anything containing calcium either, as well as not with Levo.

I read that the reason is that calcium either coats the Levo or iron, or forms an inactive compound with them, so they can't be absorbed.

Not sure what happens with tea and coffee but probably (as well as the calcium if you have it with milk) it's probably something similar. At least you can take food with iron tablets. Almost anything seems to affect absorption of Levo! Though you could perhaps get away with it if you took a higher dose.

...Except Levo and iron are best taken with vitamin C which actively helps absorption (because it raises the stomach acid I think). So an hour or so after taking Levo fruit juice instead of tea or coffee is probably OK.

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As far as I know, coffee doesn't contains calcium at least of course as you mentioned if you combined with milk. You can put less coffee or more water to softer the taste if you don't like it. Also tea don't either contains calcium (again, of course if you combined with milk). Give you best wishes on your process.

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It must be something else in the coffee: maybe caffeine makes a complex with Levo as well.

Whatever, coffee, though also very slightly addictive, is fine with other things. I felt quite shaky (hypo) yesterday evening in church and had to have a strong coffee afterwards with plenty of sugar! Thankfully I wasn't driving that time. Sometimes I run out of steam quite suddenly, and my brain won't function properly. I once had to get a lift home and leave the car behind (felt fine, then started to become clumsy and nearly dropped a tray of glasses - definitely not safe to drive!

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ddddaaazzzz and Jnetti

Caffeine can affect the absorption of Levo

"Researchers have found that for patients taking levothyroxine tablets, absorption is affected by drinking coffee within an hour of taking thyroid drugs. This is why experts recommend that you wait at least 60 minutes after taking the levothyroxine to drink your coffee."

verywellhealth.com/coffee-a...

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I do wonder what the mechanism is so looked it up - always nosy!!!

It seems that caffeine, being a stimulant, increases the rate the thyroxine passes through the intestine, so not as much is absorbed.

verywellhealth.com/coffee-a...

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Ah, same link as me!

Always a good site for information, Mary Shoman is very well respected.

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Oops, didn't notice. Confirmation! :-D

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Maybe keep your levo next to the bed then you'll see it at night, or on bathroom windowsill. I kept my NDT next to the bed so never forgot it at night. I'm now trying levo but keeping it in kitchen cupboard (as I don't want to take it very last thing) I have put a reminder on my phone (to repeat every night) to remind me to take it. Can't advise about the other meds sorry.

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You get up at 4:30 drink (1) cup of coffee or more then one cup and do you eat at this time ? I take my first pill at 4:15am go back to bed for and hour then I get up and drink my coffee I then eat breakfast by 8am and take my final thyroid pill by 10-10:15am and I take no regular meds until 2-3pm....I wrestled with the times I take my thyroid meds because I take everyday meds and my stuff all interferes with thyroid meds. Sleeping....yeah I sleep alot too 7-9 hours after doing absolutely nothing all day.

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Gets complicated doesn't it!

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Quick way to drive yourself insane...lol

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:-O

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A weekly pill dispenser by the bed is the best way to remember to take your Levothyroxine everyday

Fill it up once a week. Easy to see if you have forgotten a day. Just take both the next day, if you do forget

Like many, many others, I found taking Levothyroxine at bedtime significant improvement

verywell.com/should-i-take-...

Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine

Calcium rich foods should be four hours away from Levo. Most breakfasts include milk/yoghurt

btf-thyroid.org/information...

endocrineweb.com/conditions...

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Hi Eliana1

You can take your thyroxine and Fluoxetine anytime of day or night. Medicine like these which are taken once per day are excreted from the body slowly. The level of drug in your bloodstream builds up slowly but also drops slowly. Therefore if you miss a day by accident it isn’t such a disaster because there will still be some drug in your circulation. Compare that with a drug like paracetamol for example, which is excreted quickly and needs to be taken 4 times a day. So, my advice is take them whenever you want, but try and get into a routine so that you do so at the same time every day. It’s easy to forget to take them so you need to work out your own strategy to avoid forgetting. I would recommend at night and then see if you wake up easier?

Don’t worry about the coffee. Maybe just avoid your morning caffeine hit?

Don’t worry about the Vit D. Anytime.

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