What is the safe time between taking levothyroxine and omeprazole, 6 hours?

[FarmerDJ]

Hi I'm new to hypothyroidism after Radioactive iodine treatment and have graves. I'm also still under adjustment of levothyroxine 100mcg at present and am getting heartburn quite a lot. I used to take omeprazole for acid reflux and understand that it affects the absorption of levothyroxine. Can I still take omeprazole after 4-6 hours of taking levo, is this safe?

[Greekchick]

You can take the omeprazole 4 hours before or after and you are OK . I have to take a PPI occasionally and that’s what the pharmacist told me. Hope this helps. All the best with your treatment and your Graves. Hope you are feeling better soon.

[FarmerDJ in reply to Greekchick]

Thankyou I had read a few differing between 4 and 6 hours. I am going to take the plunge and resolve the burning as it's getting stronger by the day untreated.

[Greekchick in reply to FarmerDJ]

What helps as well if you are not already doing so is do drink water frequently. I don’t know if you have other health problems that keep you from consuming too much liquid, but I have found water helps a great deal with stomach acid as well as the PPI. I think mandyjane has some helpful hints in her answer to you too.If you are really worried about the timing, stick with the 6 hours - either way I think you will be OK. All the best.

[Hidden]

Has the acid reflux occurred after the surgery or did you have it before. It maybe that your thyroid replacement is not optimal which can lead to acid problems. Perhaps you could post your latest bloods. The problem with omprezole and the like is that they stop your stomach producing acid but the acid is needed to digest food properly so taking it frequently can lead to nutrician problems like low iron or B12 or any vitamins really. There is also a theory that your stomach has valve that needs a certain amount of acid to close properly and that a reducation in acid leading to a weak valve response is what causes heart burn. Being hypo reduces stomach acid. I am not sure how long you need to wait between levo and PPI medication but I am aware that vitamin C helps you absorb thyroid hormones better, so maybe take them with vitamin C if you are going to take the PPI later.

[FarmerDJ in reply to Hidden]

To be honest I've had it at both stages of hyper and hypo. My GP has the blood results so I cant post them. I'm constantly bloated since taking the radioactive iodine treatment, both during and after and get even more bloated after food.

[Hidden in reply to FarmerDJ]

I take something called super enzymes make by a company called NOW. I buy on amazon, reallyhelps me with any digestive issues. It contains various digestive enzymes such as pancreatin, HCA, pineapple stuff and papaya extract ad some bile. It work really well for me re occasional acid and bloating or IBS symptoms.

[FarmerDJ in reply to Hidden]

Awesome, I'll definitely take a look at that and see if it helps, thanks.

[MrsGraves]

Hi. I had raging heartburn when my hyperactivity with Graves was at its worst but the heartburn disappeared once medicated. After RAI when I entered the underactive world, I noticed the heartburn came back whenever I needed an increase in Levo. Doc had also given me Omeprazole (they dish them out like sweeties round here - everyone and their granny is on them) but to be honest they did nothing for me so I ditched them so can’t help with your query. Might it be worth getting your levels / bloods checked to see if you need an increase in Levo?

[FarmerDJ in reply to MrsGraves]

That makes sense, I'm due for another blood test in a week and will no doubt get my second adjustment of levo. Maybe then I'll not feel like a backfiring dragon!

[MrsGraves]

Ah that’s excellent - hopefully a hike in your Levo will do the trick.

[SlowDragon Administrator]

Low stomach acid is common is under medicated and still hypothyroid

100mcg is not a large dose

Guidelines suggest dose of Levothyroxine should be around 1.6mcg per kilo of weight

Low vitamin levels are also extremely common and may need improving to help thyroid hormones work better

What vitamin supplements do you currently take

Bloods should be retested 6-8 weeks after each dose increase (or brand change) of Levothyroxine

For full Thyroid evaluation you need TSH, FT4 and FT3 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. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

Always take Levo on empty stomach and then nothing apart from water for at least an hour after.

Many take Levothyroxine early morning, on waking, but it may be more convenient and possibly more effective taken at bedtime.

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

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients. Teva is the only brand that makes 75mcg tablet.

Many people find strictly gluten free diet helps improve poor gut symptoms especially with Graves' disease of Hashimoto's




Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

[FarmerDJ in reply to SlowDragon]

Next week I'll be having another full T profile test along with u&e, liver, bone and blood count which I always do first thing in the morning before food & meds. I dont take any supplements unless my gp says I need them as usually he will call me if anything shows up as being too low or high. It's been 2 weeks since my last blood test and 100mcg has made a little improvement but not enough so hopefully next weeks test and increase will see a better improvement of the symptoms.

[SilverAvocado]

FarmerDJ, I'm not at all an expert on this topic, but the big problem with PPIs is that they lower stomach acid on the assumption our reflux is caused by too much acid. But often thyroid patients will be having reflux because acid is too low. Low acid causes other problems, like lack of vitamin absorbtion from food, and vulnerability to food poisoning and other infections (because our acid is not strong enough to kill off bugs in food).

You can do a simple home test called the Burp Test, Google for details. Basically you take a teaspoon of bicarb in water and time how long it takes to burp. With good acid the reaction will happen almost immediately, and resultant gas needs to be burped out.

Low acid can be treated by taking apple cider vinegar in water with meals. Or if you need more acid than that, Betaine hydrochloride tablets. Digestive enzymes can also be taken as a tablet and I found it a big help.

These things are also much more gentle treatments. Acv even has a lot of other health claims associated with it. Whereas PPIs can have terrible side effects, especially in the long term.

[FarmerDJ in reply to SilverAvocado]

Thanks, I've done some research after reading everyone's comments on enzymes and am going to introduce some apple cider vinegar and pineapple & mango to see if this helps. Carbs seem to cause me bloating problems and heartburn. So happy this forum exists because GPs and consultants dont tell you any of this and everyone here has been amazingly helpful.

[SilverAvocado in reply to FarmerDJ]

You're very welcome! Good luck, I hope you find something that helps. It's a great feeling to lie down at night with no reflux.

[Greekchick in reply to FarmerDJ]

Just be careful with too much ACV - it apparently wears away the tooth enamel over time - I would brush my teeth after drinking anything with that in it. Good luck with everything.

[FarmerDJ in reply to Greekchick]

Thanks I'll be careful

[helvella Administrator Thyroid UK]

Did you, by any chance, notice my post the other day?

Stomach acid-reducing drugs may raise risk of future allergies

healthunlocked.com/thyroidu...

[FarmerDJ in reply to helvella]

No I didn't see that post but I tried eating pineapple as someone suggested and it helped to clear the bloating problem almost immediately each day. A lower sugar alternative would have been a better answer from my GP than simply doubling the amount of omeprazole to 40mg. The omeprazole I would rather not have to take.

[SilverAvocado in reply to FarmerDJ]

FarmerDJ, could you explain a tiny bit more about the pineapple? Is this in tablet form or the actual fresh fruit?

[FarmerDJ in reply to SilverAvocado]

I am eating a little of the pre-sliced fresh fruit when I feel bloated and instantly I feel much better and not so bloated. After some research I found it contains bromelain, an enzyme the body needs to break down proteins. Being hypo is suggesting that enzymes are low too. It definitely did the trick for me.

[SilverAvocado in reply to FarmerDJ]

Very interesting, adding the fresh fruit to my usual diet is something I'd definitely enjoy!

[FarmerDJ in reply to SilverAvocado]

I have to admit I was a little sceptical at first but I did the job each time I felt bloated. Papaya contains papain, another enzyme very similar. I haven't tried eating that yet but give it a go when you feel bloated. The proof is in the pudding as they say 😁

[SilverAvocado in reply to FarmerDJ]

Yea, it's so much nicer to be eating proper food instead of tablets. And like you say, shocking that doctors are so quick to prescribe nasty medications with side effects.

I'm quite a fan of pineapple anyway, but I don't often bother because of all the chopping up. I will have to give it a go

[FarmerDJ in reply to SilverAvocado]

I dont like the chopping up part either so buy the pre chopped prepackaged version and it works just as well.. instant burps too lol

[SilverAvocado in reply to FarmerDJ]

I'm still not very mobile and rely on grocery deliveries. I only get one every two weeks from a supermarket that will have the pre-chopped, so am now planning to get some of that and also try out frozen. I think they do it in smoothie packs.

I had a quick search and sounds like tinned doesn't have the bromelain but frozen probably does.

[FarmerDJ in reply to SilverAvocado]

Sorry to hear that you have mobility issues.. will be interesting to hear how you get on with it. You can also buy the active enzyme in a pill form online if that helps you.

[FarmerDJ in reply to helvella]

An interesting post and I am not really surprised by this. I wish that GPs would have a little holistic training to be able to understand and provide a healthier cure instead of simply over prescribing medication that we dont really need and ultimately costs the NHS.

[FarmerDJ]

Thankyou I will suggest changing them as I am a long term user.