I started taking 50mcg levo almost 4 weeks ago. I decided to take it at night as I always get up late. For some reason it just never occurred to me that I shouldn't be taking it after eating at night. I don't mean after a meal but if I take it about an hour after eating, say, a piece of toast would that affect it greatly?
After seeing a nurse practitioner a few weeks ago she prescribed levo. I'd said I was feeling tired so she ordered a raft of blood tests. I want to upload photos of my results but unfortunately I can't put all the info in one photo and I can't upload more than one at a time. Is there a way to do this? Can I upload more photos in the comments? I've also tried copying and pasting the info but it hasn't worked.
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AnneEvo
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Afraid one photo per thread is all that is possible. Two options to get round this, post as text within a post or reply, or post an image to a file sharing site and put a link here.
(Adding photos to several threads makes it very difficult to follow.)
Thanks. I scanned the results but messed about with the document yo get rid of ecxess info. Then took pics with my phone. I'll fold the 2 documents and scan as 1, if that doesn't work I'll do what you suggest and use a file sharing site.
I’m not sure eating a small meal one hour before taking levothyroxine will have much effect. I wouldn’t worry about it. If it’s occasional it will have a small effect due to the long half life of thyroxine. If it’s regular and if there were a small reduction in absorption it would be factored into your titration. e.g. if you were absorbing 5 or 10 percent less you would be prescribed 5 or 10 percent more levothyroxine to achieve the same status.
I have a feeling it's 2 hours before and 1 hour after ideally. I used to have breakfast half an hour after taking it and was still symptomatic but the meducation was new and hadn't all kicked in by then. These days, I tend to take it in the middle of the night when wake up briefly (happens most nights) which negates food and supplements issue (vitamins need to be taken 4 hours apart from levo).
I am noticing how often I call myself an idiot or other hyper-critical comments,silently,or under my breath.I am trying to change this.I am human.I make mistakes,usually not as big as my inner judge tries to convince me.
You’re not an idiot, unlike the doctors and medics whom slavishly state that levothyroxine should be taken all at once 3-4 hours or more away from last meal and an hour before the next. This is based on drug company optimums for their products based on research on on absorption under normally varying circumstances. I haven’t seen any research which states levothyroxine doesn’t work at all if it’s not taken hours away from food. Whereas the potentially much more significant factor is the amount of levothyroxine that suprresses deiodinase enzyme activity that provides the majority of our bodies needs for t3 from t4 gets almost no consideration by the medics or the pharmaceutical companies.
Absorption of levothyroxine has been shown to vary only between 60 - 80% and so if you take it as per this ‘received wisdom’ and drug company information yes, you will get greater amount of t4 from less levothyroxine and the dose can be consistently assessed, in theory. But there are many factors affecting individual uptake and response to levothyroxine and variable absorption is just one of them and can be managed by finding what dose works for you at whatever time you take it and being consistent with your habits.
Personally I find single larger doses of levothyroxine are disruptive and less effective than splitting my 100mcg daily need into 4 x 25 mcg doses even if 2 of these doses are close to food and drink. The only thing I’m wary of is iron supplements, coffee and certain drugs on the ‘affects levothyroxine list’ e.g. some types of antibiotic and antacids. I take vit c with the doses near food because because is said to assist absorption but again it’s about consistency, even if you’re only absorbing 60% you can take enough to compensate and stick with it!
The actual difference in amount absorbed on a 100mcg dose, according to the research would be 80 - 60 = 20mcg, which would need a 20% overall dose increase, if you were taking every dose with food! In practice when you split dose some will be under circumstances of higher absorption and some lower, so overall absorption could easily average 70% and the difference in dose required becomes much smaller and maybe completely insignificant. Your actual overall absorption could well be practically irrelevant, you don’t even need to think about it if a consistent dose regime is established and delivers wellness. As I said the biggest issue could be whether single large doses of levothyroxine are actually reducing t3 conversion compared to several small doses over 24hrs.
I remember asking my doctor (after realising my mistake taking it with vitamins in the mornings) if I should split it. The response was no when you get up in the morning it kickstarts your metabolism so it’s the best time. I was going to work with no breakfast now I’m taking my 150 at bed time. I’m not feeling great also my doctor says that although my T4 is running a little over normal he prefers that when it’s hypothyroidism controlled by levothyroxine. It’s only since that I have noticed in the hospital letter to him that it says. T4 slightly high, very little T3 uptake (boarderline) possibly due to problems with pituitary gland. It’s a mine field you have to try to trust your gp but I’m tired stressed and depressed I get very bloated too, my shoulder pain is some days unbelievable, I have had so many health issues it’s terrible. Any advice anyone?
That doctor was idiotic! T4 doesn’t kick start your metabolism and in doses like that it possibly does the opposite! Little and often is the normal healthy thyroid output of t4 so mimic that and see what happens...... you don’t have to trust your GP, mine admits he knows very little about thyroid, they don’t have the training or the time! My t3 went up when I established split dosing and that was with no change in total amount of levothyroxine, which fits the theory (research based) that t3 is suppressed by high levels of t4. A healthy thyroid gland does not deliver 150mcg of t4 in one go, whatever time of day you look at!
Yes, I can confirm that when I asked my Endo about taking more T4 he said that too much T4 would send my T3 down.I take100/75 T4 alternate days +10mcgs T3
And something else: T3-uptake has very little to do with T3 (either free or total) it is a measure of how much thyroid binding globulin (TBGs) you have in your blood. TBGs are binding proteins that transport hormones around the body to the cells. I am not sure why they call it T3-uptake unless they measure the availability of TBGs by detecting how much T3 is bound i.e. taken up. The measurement itself is a bit of a mystery, it is a percentage. Now if that number is low, surely that is "good" because you are only using up a small percentage of your TBGs thereby leaving a lot more for other things to use the transporters. (very important if you are needing another medication which interacts with thyroid meds). If that % is high then there is no more room for anything else to use the TBGs. Maybe that is why the upper normal % is about 30%.
But in conclusion, i do not think your doc knows too much about the thyroid. Join the club.
I've just re-read your responses as someone posted a reply to my post today. Thank you for your view. I have been thinking of splitting my dose because most days I get tired for a while in the afternoon but I'm only on 50mcg, would it still be worth it?
The response was no when you get up in the morning it kickstarts your metabolism so it’s the best time.
Any doctor who says that is completely missing the realities of thyroid.
1) A real, working thyroid releases tiny amounts of thyroid hormone through the day. The one-a-day tablet is so very different to that. It is entirely inappropriate to want a kickstart. It would be far more appropriate, were it feasible, to have an automatic release that emulates a real working thyroid.
2) Kickstart implies that it acts like, for example, caffeine. It doesn't. Proper thyroid hormone levels help with sleep as well as with wake.
3) The taking of levothyroxine is just the first step of many. Take. Absorb. See T4 peak in blood stream some two hours later. Bind to thyroid binding proteins. Release from being bound. Convert to T3. Then that T3 has its effects on cells. This doesn't all happen within minutes, or even hours, of getting up. It takes hours and days for everything to flow through. We see even people on T3 discussing the fact that its effects on cells can continue for at least two days.
I’m not sure of the exact chemistry of coffee and levothyroxine other than it’s a binding of constituents rather than ph - levothyroxine generally absorbs best in low ph acid conditions and coffee is acidic yet still adversely affects absorption, some research I have seen expressly mentions espresso coffee as being the worst culprit and there’s probably a detailed biochemistry of the interaction online somewhere! Whatever I keep coffee and levothyroxine 2 hours apart.
I said I was an idiot as I think if I was taking levo in the morning I would've taken it an hour or so before food but for some reason I seemed not to make the connection between food and levo in the evening. But it seems I was worrying too much.
I do tend to usually point out anytime I am an idiot or being dozy before others notice
This a direct quote from a scientific paper on how the body is wired to protect t3 levels....
“Perhaps the most dramatic deiodinase-mediated homoeostatic mechanism is the post-translational loss of D2 activity induced by interaction with T4 via conjugation to ubiquitin. 3,48 D2 is a type I endoplasmic reticulum (ER)-resident D2 with a variable short half-life that depends on whether its natural substrate T4 is available. In the presence of T4, D2 is inactivated with an approximately 20 min half-life, whereas in the absence of T4, its half-life is prolonged to hours. 49 This provides a mechanism through which the production of T3 can be regulated according to the availability of T4.”
This negative feedback effect of t4 on D2 activity is repeated in medical texts and other scientific and research papers.
..... so here’s my interpretation; as t4 levels increase d2 activity is reduced and t3 conversion falls, if the cellular t4 levels are in flood after absorption of a large dose which peaks over 2-4 hrs d2 activity is reduced and yet we actually wanted all the t3 that t4 was assumed to provide. Even if t3 production rises through more D2 activity as t4 falls after peak dose absorption we have already induced a period of less than optimal t3 by raising free t4 far more than a healthy thyroid would have done and maybe this shortfall is never made up with standard levothyroxine dosing because it’s all or nothing! After that big dose the body has to adjust and there’s no more coming until the next dose, unlike the continued moderate 24hr output from a healthy thyroid....... I’m sure the medics would say yeah but the body can store the t4, it lasts for days blah blah but..... it ain’t physiologically normal, the healthy thyroid stores iodine not t4. T4 is in constant dynamic equilibrium the only source to replace metabolic clearance which is more or less fixed is thyroidal secretion and studies show that this is pulsitile with only narrow variations over 24 hrs even if the total levels go up and down according to need for t3!
If any dose causes suppression or even sub optimal t4 to T3 conversion I would argue it should be split. The challenge is knowing the levels that occurs. So I take a somewhat simplistic view that if a healthy thyroid gland does not produce all the t4 over just a few hours in any 24-hour period then there must be a question mark over trying to replace it with a single dose of levothyroxine that is absorbed over just a few hours. The scientific data on normal free T4 levels are more or less consistent through each and every 24-hour period fluctuating only with the bodys autonomous self regulating activity to provide T3. Why does T4 replacement have to be in such a crude unphysiological fashion? Answer, it doesn’t!
I always take mine at 11pm and finish eating/ snacking anything by around 8:30-9pm and nothing after 11pm either. I wouldn't risk eating or drinking anything aside from water which is tough as my oh loves to snack though out the evening which just makes me hungry lol. I don't know enough about this and there are others so much more knowledgeable than me on here. This is just my routine. Best wishes x
I recently read on Dr Myhill's website that taking t4 with food in the evening is fine, but I expect probably best to avoid tea, coffee and the majority of supplements at the same time.... the key to success is helping things along by focusing on good conversion to t3.
I eat mine with my breakfast usually - randomly before or after and have never noticed a difference.
I should add at one point I started taking a supplement, I think it was cod liver oil at the same time, and I did think maybe that interfered with absorption. Being oily this seemed logical, so I did space that in time from my levo.
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now I’m taking my 150 at bed time. I’m not feeling great also my doctor says that although my T4 is running a little over normal he prefers that when it’s hypothyroidism controlled by levothyroxine. It’s only since that I have noticed in the hospital letter to him that it says. T4 slightly high, very little T3 uptake (boarderline) possibly due to problems with pituitary gland. It’s a mine field you have to try to trust your gp but I’m tired stressed and depressed I get very bloated too, my shoulder pain is some days unbelievable, I have had so many health issues it’s terrible. Any advice anyone? 
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