Taking levothyroxine

[Choirgirl1]

Is it better to take thyroxine at night or in the morning?

[SlowDragon Administrator]

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

Many people 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.

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also 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).

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

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 (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

You are legally entitled to printed copies of your blood test results

If you change taking Levothyroxine from morning to evening, ideally you should retest bloods 6-8 weeks later

[Choirgirl1 in reply to SlowDragon]

Thanks for the advice.

[Patient_0 in reply to SlowDragon]

Hi, you mentioned TSH levels should be under 2 or 1. What are these numbers based on? Is there any scientific or clinical evidence for it?

[SlowDragon Administrator in reply to Patient_0]

Median TSH graph

healthunlocked.com/thyroidu...

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

please email Dionne at

[e-mail]

New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levo thyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

NICE guidelines

cks.nice.org.uk/hypothyroid...

The initial recommended dose is:

For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.

This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.

New NICE guidelines

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

[helvella Administrator in reply to SlowDragon]

(rounded to the nearest 25 micrograms)

On that basis, someone of anywhere in the range 87 to 120 pounds would appear to need 75 micrograms. Working that back, it results in a range from about 1.38 to 1.90 micrograms per kilogram. That is, someone at the top of the wieght range would only be getting 1.38 micrograms per kilogram but someone at the bottom of the range would be dosed nearer 1.9 micrograms per kilogram.

At each end of the weight range, a small inaccuracy (in weighing, in coverting from pounds to kilograms, or whatever) could easily result in a dosing in the next range (50 or 100 micrograms).

[SlowDragon Administrator in reply to helvella]

It's a start .......

can be useful as good argument with GP if left on 50-75mcg (as many, many people seem to be)

[Lalatoot]

It is whatever suits you and your lifestyle as long as you are consistent as the body likes to have its fix at around the same time each day. I found it hard to take enough thyroxine in one dose so the endo suggest I split it. I currently take 50mcg around 6am and the other 50mcg at around 4:30 pm. The second dose is timed so as stomach is empty after lunch and there is time to absorb before evening meal. This also means I can eat and drink whenever I want to right up to bedtime.

[Choirgirl1 in reply to Lalatoot]

Thanks for the advice.

[SlowDragon Administrator in reply to Lalatoot]

Lalatoot

Interesting...I also split my Levothyroxine dose (only started splitting it a few months ago) 100mcg at bedtime and 25mcg waking

In theory It shouldn't make any difference as it's a storage hormone ...but I find it an improvement too

[Lalatoot in reply to SlowDragon]

I felt sick if I got too much in one go. As a teenager I was always sick for a couple of days when my period started so I assume I am sensitive to hormonal variations. I also felt that by splitting the dose if absorbtion was compromised at one part of the day there was a hope that it would be optimal at the other dose. Originally I did morning and bedtime.