Hi,
I am on 100mg of levothyroxine which I take first thing in the morning normally about 40 minutes before food. I've just had some recent bloods done and my calcium is low so I've been prescribed Adcal D3 to take twice daily, would anyone know whether I can take these tablets at the same time as my levothyroxine as there is nothing on the box or leaflet to mention any thing and I rung the pharmacy to ask them and the guy seemed unsure.
Any help would be great.
DonnaT86
Vit D and Calcium should be taken 4 hours away from thyroid meds.
Also, Levo should be taken on an empty stomach, one hour before food or two hours after, with water only (no tea, coffee, milk, etc) and water only for one hour each side.
Oh wow I didn't realise I had to give it an hour before eating or drinking with thyroxine, sometimes I have a coffee just half an hour after taking my tablets thank you for telling me this and with also the calcium tablets.
taking levothyroxine on an empty stomach an hour before breakfast and especially coffee is considered 'the norm'. This is the first time I've hard that NOTHING except water should be taken. Can you supply some references for this or is this just your routine.
Nothing but water: tpauk.com/main/article/how-...
Make Sure You Drink Enough Water
..... To “propel” the pill down to the jejunum you need to drink a full glass of water about 300ml (half a pint)..........
......... It is critical to allow at least one hour before eating or drinking anything else, to allow the medication to be absorbed and converted correctly in the body.
Coffee (also caffeinated tea, hot cocoa, or caffeinated soft drinks): verywellhealth.com/coffee-a...
verywellhealth.com/how-to-t...
Milk (and non-dairy milk fortified with calcium): endocrineweb.com/conditions...
A question in this context: should cod liver oil also be taken at least four hours away from thyroid meds? It contains both iron and vit D.
I was unaware that cod liver oil contains iron.
Cod liver oil is not something I would take so I'm not speaking from personal experience but I would say take it 4 hours away from Levo as it contains Vit D.
In fact, cod or any fish liver oil does NOT contain iron, I was thinking of dried beef liver...fish oil contains almost the complete recommended daily amount of vits A and D.
I have never waited for my cup of tea in 18 years after taking my levo dose. Never had a problem. Also when I first started taking thyroxine I took a 50mcg tablet 3 times a day and ate immediately afterwards as I did not know any different. So perhaps waiting 1 hour is not always necessary but maybe preferable.
If you've always done things that way then I expect your dose of Levo takes this into account. The absorption is likely to be affected and your dose is appropriate in your circumstances.
Donna, have they explained why they think your calcium is low? I see you’ve had a total thyroidectomy. It’s possible your parathyroid glands were damaged. nhs.uk/conditions/hypoparat...
Leave a couple of hours between thyroxine and Calcium. I take regular thyroxine and calcium since my total thyroidectomy 2017, they damaged my parathyroids. I have to take both. If you haven't had vit d tested I would do so and also take some vitamin d pills each day helps absorb the calcium 😊
Four hours, or calcium will bind with the thyroxine and you won't absorb either. 
I take my thyroxine normally at 3am so I don't take near any calcium or any meds. Thank you for you input never knew was 4 hours cause not relevant for me thought a couple only. Have a nice day 😊
Thank you. You too.
I'm not sure I agree with you there, greygoose.
The ratio of calcium to thyroid hormone is huge. Calcium doses are often many hundreds of milligrams. And I'd expect no more than one milligram to intereact with the thyroid hormone. Which is a forgettably small percentage of the calcium dose.
There could be other ways in which calcium absorption is affected by thyroid hormone, but I don't know of any.
Low calcium is often due to low vitamin D
Low vitamin D extremely common when on Levothyroxine
What was your vitamin D result?
You are legally entitled to printed copies of your blood test results and ranges.
UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.
In reality many GP surgeries do not have blood test results online yet
Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.
For full Thyroid evaluation you need TSH, FT4 and FT3 tested. Also important to regularly test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common on Levothyroxine
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).
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
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 (and calcium supplements) for at least four hours from taking Levo)
Previous post
healthunlocked.com/thyroidu...
Essential to test TSH, FT4 and FT3
TSH is frequently misleading after thyroidectomy.
Hi I have to take calcium have hypoparathyroidism x
Take cakcium with or just after food too 😊
You could take your Levothyroxine at bedtime if you haven't eaten anything for a while?
I wouldn’t. I would leave at least an hour before taking any other meds. My dr told me u have to leave half hour between talking Levo and eating and drinking. It’s so difficult. I now set my alarm for 5am and take my levo then go back to sleep. When I wake at 7 I am free to have my breakfast.
Wow thank you everybody for all your responses.
With regards to my calcium my consultant told me my calcium was low and told me take these adcal d3 tablets and then have another blood test in November and he's going to test for my parathyroid, vitamin D, calcium, full blood count etc but I am surprised they didn't ask for me to have more bloods done soon rather then wait till November.
I had my calcium tested when I had my thyroid out last November and my calcium levels were normal so they are saying the calcium is not to do with the surgery.
They have also told me to take a higher dose of my thyroxine as my TSH is creeping up quite quickly it's at 4.3 right now but my T4 is normal at 11.9, they never seem to test for my T3 they say they don't need to test that now my thyroid is out lol.
Many doctors believe that testing T3 is unnecessary, but frankly that's B.S. It is what they were taught in med school and it is what many practice guidelines say. Nevertheless, it is still B.S.
Whether you have a thyroid gland or not, you may, or may NOT have sufficient levels of T3. Your body will convert some of the T4 (regardless of whether you took it as medication or whether your thyroid gland produced it) into T3 by removing one atom of iodine from T4, leaving the molecule with THREE iodine atoms.
T4 is the storage version of the hormone. T3 is the active version that gets into all the cells of your body to keep you healthy. If your doctor refuses to test "Free T3" (FT3) you can have your blood tested by a private lab. Then you can take the results to your doctor and ask for a trial of T3 if yours is low. If the doctor refuses, look for a new doctor.
I was taking plenty of T4, so both my Free T4 and TSH were within range, but my T3 was under the bottom of the range. When I began taking T3 several of my hypo symptoms were corrected: I was able to begin losing weight again on my low carb diet that I had been following for 2 years. My chronic constipation went away. My Cholesterol tests came back in healthy range, and my hemoglobin A1C showed that my blood glucose levels for the previous 3 months were in normal range.
Is T3 available in the Uk. ? I too have had a sub total thyroidectomy, when I was twenty something. After radioactive iodine and carbimazole would not stop it. I’m sixty now but always told it’s “ within normal range” but I do not feel like it is. I’m happy you feel better with T3. So fed up of endo and doc telling me alls good.
I am on 150 levo
Hidden
First step is to get full Thyroid and vitamin testing, most likely privately
Your GP may test vitamin D, folate, ferritin and B12 if you ask
GP is unlikely to be able to test FT3. Most NHS labs refuse to test......But if due Thyroid test, you could ask
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 or vitamins are low
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).
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
Start a new post with your most recent (or new) blood test results and ranges. Members can advise on next steps
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
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)
Many people find different brands of Levothyroxine are not interchangeable
Are you in the UK?
Getting full Thyroid and vitamin testing strongly recommended
At very least testing Vitamin D £29
Parathyroid is difficult test to get privately as it's time sensitive and needs rapid processing
FT4 result looks low. What's the range on FT4 test?
Should be in top third of range
All Thyroid tests done as early as possible in morning and fasting and last Levothyroxine dose 24 hours before
D3 is fat soluble so needs to be taken with dietary fat, eg fattiest meal of the day.
What form of D3 are you taking - tablets, capsules, softgels, oral spray, sublingual liquid?
D3 has important cofactors that are needed. D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking tablets/capsules/softgels, no necessity if using an oral spray
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking tablets/capsules, no necessity if using topical forms of magnesium.
naturalnews.com/046401_magn...
If you o to make 1am you regular time that's fine as long as its atleast a couple of hours after food or milky drinks or other meds 😊
Thankyou. 😊
NHS endocrinologist is extremely unlikely to take any notice of vitamin levels unless deficient or do full Thyroid testing. They don't want to test FT3 as don't want to have to prescribe if
Vast majority of Uk patients forced to get private testing
Suggest you start your own post with most recent results and ranges
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
Fibromyalgia is often linked to low FT3
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.
Collecting paper prescription from GP surgery enables you to take prescription to different pharmacies to make sure you always get same brand. Many people find it essential to stick to same brand of Levothyroxine
Levothyroxine should always be taken on empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and more effective taken at bedtime
All other medication at least two hours away from Levo. Some like HRT, PPI's, magnesium, iron or vitamin D, at least four hours away
Hi no its no problem at all if it means others get answers to that's great.
It is a complicated issue and unfortunately alot of consultants will only look at the blood results rather then go by how your feeling.
My anxiety has been awful lately, work is extremely stressful of late but I feel like the anxiety is even worse because of my condition, my chest is tight, I struggle with breathing, headaches, feeling like I'm out of it it's a horrible feeling but Dr's don't take u seriously and I'm worried I could end up really ill if this carries on.
Fingers crossed we get sorted eventually.
Awww your A Donna too 👌🏻
I have started taking my levothyroxine when I wake up between 4.30 and 5am when I always get up to the loo then. I had been taking it at bedtime, but found I was having a few palpitations and loud swishing in my ears quite a lot during the night. It has improved no end, though I still have some ear swishing (I produce an awful lot of ear wax, which seems to be the main cause, I think) if I lay on that ear. I too also had low calcium levels and was prescribed Fultium, only to be told on my last blood test my levels are now dangerously high! It seems we can’t win! I believe there was also something about the NHS not prescribing vitamins when they could be bought over the counter, which may be more likely.
Hope this helps.
I have heard various worrying things about Adcal. Others on this forum may know more about this.
You are entitled to a Patient Information Leaflet (PIL) every time you get a prescription dispensed. If you ask for that, it must be the one that applies to the product supplied. You might need to receive two PILs - one for the 50 microgram and another for the 100 microgram - depends if they are the same make and if the PIL covers both dosages.
I suggest you also request they write the batch (lot) numbers and expiry dates on the PILs. Otherwise you have no idea.
If you describe both sides of the tablets - any markings, score lines, letters, numbers - we can readily identify them for you.
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