Transition from taking levothyroxine from morning to night

[M33R4]

Ok so I feel too foggy headed taking my 75mg levothyroxine when taken in mornings. I work in IT and have to resolve IT Issues all day and I work full time. I cannot afford to be foggy headed. I therefore asked my GP if I could change from morning to night in taking my medication as I may sleep off most of the fogginess. She advised against changing to nights as this decreases the effectiveness. Is she right? If I took advice on here and changed to nights what's your advice about the transition please? Thanks

[MaisieGray]

Your Dr is simply wrong, and they aren't qualified in pharmacokinetics to have an expert view on the subject of how and when drugs should be taken. Perhaps you could show her this study, which concluded: "Levothyroxine taken at bedtime significantly improved thyroid hormone levels. Quality-of-life variables and plasma lipid levels showed no significant changes with bedtime vs morning intake. Clinicians should consider prescribing levothyroxine intake at bedtime."

jamanetwork.com/journals/ja...

[Judithdalston]

Well it doesn’t sound like you feel the am dosing is working...so try bedtime, or if you wake up in middle of the night, to perhaps go to the loo, take then. The advantage of night time is it is taken well away from food/ drink, though you might take other bedtime pills/ supplements. When you take it shouldn’t really matter as Levothyroxine has a long half life so you should not feel like you are ‘running out of’ FT4 in the blood, which can be the case with T3. Are you sure you are actually taking enough levo; had your TSH, FT4 and FT3 tested recently?

[M33R4 in reply to Judithdalston]

Only just been started on 75mg and not had my 1st test yet so don't know if dose is appropriate.

[Judithdalston in reply to M33R4]

Ok, so no thyroid blood test results as yet, not even TSH? How were you diagnosed? Do you know if you have thyroid antibodies ( tested as TPO, and less regularly TgAb which on this forum generally diagnoses Hashimoto’s disease)? Also if at beginning of hypo diagnosis worth getting folate, ferritin, b12 and vit D tested....your Gp may not know Hashimoto’s compromises our gut and we regularly have low ( if not worse- deficient) nutrients which in their own right can give us symptoms from fatigue to hair loss, but also low levels ( ours should be high optimum) hamper our thyroid health. Look up Seasidesusie’s past replies re supplementing....it can be an important part of feeling better. Your current flagging in the morning may well be you just aren’t on a high enough dose. Your gp should test you every 6/8 weeks and then look to raise your dose 25 mcg if appropriate...your TSH should be c.1 or lower, not just in range.

[M33R4 in reply to Judithdalston]

Been diagnosed by gp bloods in January, started 75mg levothyroxine next morning on 15 January. My apologies for not being clear - By 1st blood test I meant 1st blood since starting levothyroxine.

[Judithdalston in reply to M33R4]

Ok...infact 75 mcg levo as starter dose is on the high side, and you are only 4 weeks into treatment so your body is still adjusting. One thing most hypos on this forum would say is ‘be patient’ ( sadly it takes some of us years to get better...). Have you got your blood tests that went with your initial diagnosis to share? Was your TSH for eg 10 or over? Generally onced diagnosed GPs only do TSH test (you might get FT4 if TSH is out of range, similarly even FT3, as labs can take this decision themselves). As I asked before what about two antibody tests and 4 min/ vit tests...if you Gp won’t do them I suggest you get a private lab test to get a good picture of where everything is now?

[bantam12]

After I changed to taking it at night my T3 level improved greatly.

[prussianblue]

Try taking half in the morning and half at night for while and see if there’s any improvement. Research suggests many feel better taking it at night but you will only find out by trying. Your GP won’t be able to tell any difference but be careful of timing at next test.

[bantam12 in reply to prussianblue]

There's no point in doing half and half, doing a straight swap works fine.

[M33R4 in reply to bantam12]

If tomorrow I decide to take levothyroxine at night will doing so mess up my 1st bloods tests due 25 Feb?

[bantam12 in reply to M33R4]

Better to wait 6 weeks after any change.

[M33R4 in reply to bantam12]

Agreed. Thanks

[RedApple Administrator in reply to M33R4]

Yes, it won't give an accurate picture of where you are because absorption may vary by taking it at night versus morning.

I'd suggest waiting until after the blood test and see what your results are. It may be that a dose increase will be needed.

But if after that you decide to change timing, try taking some at night and some in the morning. There is no law that says it must all be taken in the moring, or that you can't split dose it. A few people do find split dosing levo works best for them.

[prussianblue in reply to bantam12]

We’re all different bantam12, some are so sensitive to it, they would be able to determine a difference just moving half a dose.

[M33R4]

I take magnesium at bedtime or cant sleep so well. Obviously I cannot take it with my levothyroxine?

[SlowDragon Administrator in reply to M33R4]

Magnesium must be four hours away from Levothyroxine

Don't change time of taking until AFTER your blood test

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

Recommended on here that 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)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .

[M33R4 in reply to SlowDragon]

🙏 thank you so much

[SlowDragon Administrator in reply to M33R4]

Many of us notice improvements taking Levothyroxine at bedtime. Certainly more convenient

Just take magnesium early evening instead

[knitwitty]

I changed to taking my levothyroxine at night because I take a variety of supplements and I wanted to take them first thing in the morning so that I wouldn't forget and to avoid any interaction with my levo. I think my conversion from T4 to T3 has improved slightly since I changed.

I take magnesium first thing too but I also use better you magnesium lotion or oil before bed some evenings, that too has a relaxing effect and I have had no trouble sleeping when I have used it.

[M33R4]

I find taking magnesium while I am in bed relaxes me for sleep. If I dont use it by sleeping within 10 minutes of taking it it loses its efficacy. Can I not eat or drink anything for a certain period of time before taking night time levothyroxine please?

[SlowDragon Administrator in reply to M33R4]

No large meal 2-3 hours before. Nothing apart from water for at least an hour before and after

If going out and eating later than usual, just take Levo in middle of night when get up for the loo.

Some people always take middle of night

[Treepie]

I switched to bedtime without any discernible difference.Now having so many drugs to offset chemo that I am taking levo in the middle of the night when I get up for a pee thus ensuring 4hours from anything else.