Silly question

[markwsteele]

Even though I’ve been told there are no silly questions only silly answers I’m going to give this a go...

Am I going mad or have I read here/somewhere that Levothyroxine should be taken one hour before meals or drinks containing caffeine? If that’s correct what is it that caffeine does to the medication?

Thanks in advance

[SeasideSusie Remembering]

Always advised here:

Take your Levo 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 an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours.

[markwsteele in reply to SeasideSusie]

Thanks

[jimh111]

Not sure of the techincal effect but coffee can considerably reduce levothryoxine absorption. This is a good summary of the study that found coffee reduced levothyroxine absorption thyroid.org/patient-thyroid... .

[Baobabs in reply to jimh111]

But do we know if this is the caffeine or another component?

[jimh111 in reply to Baobabs]

I don't! I vaguely remember there are some studies that suggest which components have an effect but I wasn't bothered as it would have involved extra work. I have an allergy to excess work, it might be an 'x-linked' genetic condition ;-).

[Baobabs in reply to jimh111]

So funny! Possibly a symptom of Hashi's?

[jimh111 in reply to Baobabs]

I don't gave Hashi's!

[markwsteele in reply to jimh111]

Thanks

[SlowDragon Administrator]

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (note recommended to avoid calcium rich foods at least four hours away from Levo)

This may explain why so many people find taking Levothyroxine at bedtime can be more effective

Obviously most breakfasts contain calcium rich foods

[shaws Administrator]

Caffeine or food interferes with the uptake of levothyroxine or any other thyroid hormones, that's why we allow a gap between food/caffeine.

[Baobabs in reply to shaws]

I sometimes take a panadol first thing in the morning for headaches and these contain caffeine. I must stop.

[shaws Administrator in reply to Baobabs]

I assume you can take your panadol later in the morning. Or would you consider a bedtime dose of thyroid hormones. Some people prefer that but if you've had a meal that evening you'd have to allow about 3 hours for it to digest before taking hormones.

One of our Advisers took his in the middle of the night when he awoke to go to the toilet. Definitely nothing interfered with the uptake of his thyroid hormones.

[Nico101 in reply to Baobabs]

Why not take ones without caffeine first thing?

[Baobabs in reply to Nico101]

Here in Saudi they all seem to have caffeine in them. Pleased I know there could be a problem.

[MaisieGray]

Mary Shoman explains it thus: the caffeine in coffee is likely to be the cause of poorer absorption of Levo in the intestines because caffeine can produce an increase in intestinal motility, and may also induce an increase in the amount of fluid flowing into the intestines, resulting in looser stools - both of which can make oral medication pass through the intestines more rapidly than otherwise. Some of the med may also leave the body in the stool before it has a chance to become absorbed, and with lower absorption, there will obviously be less effect/lower thyroid hormone levels. Apparently Tirosint (soft gel form of LT4), and Tirosint-Sol (liquid form) are absorbed more rapidly than standard Levo tablets, and studies have shown that they can both be taken at the same time as coffee, with no negative impact on absorption or thyroid hormone levels. She also writes that this decreased absorption with coffee seems to be an issue for L-T4 only, and has not been observed with T3, NDT, or antithyroid medications, and that caffeine does not interfere with thyroid hormone function.

[markwsteele in reply to MaisieGray]

Thanks