Hi there, I had half my thyroid removed due to an enlarged cyst in February and have struggled with symptoms of hypo ever since. Doctor has just started me on a trial of levo at 50mcg. I have a few questions if anyone is able to help.
- When is the best time of day to take it?
- I understand best to leave 30 mins between dose and caffeine, and 4 hours between dose and calcium-rich foods; anything else to avoid?
- I’m on the combined pill; will these two medications affect each other?
- Can I still take a multivitamin?
- Anything else I need to be aware of?
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Jellybabyhead
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The time that suits you best. Some people take it first thing in the morning, on an empty stomach, and leave at least an hour before eating or drinking anything other than water - and that includes coffee - for maximum absorption. Other people take it before bed, leaving 2-3 hours between the levo and their last meal. And, still others, take it in the early hours of the morning, when they get up to go to the loo. You can take it at any time, as long as you respect the rules.
I understand best to leave 30 mins between dose and caffeine, and 4 hours between dose and calcium-rich foods; anything else to avoid?
An hour is better for coffee. And two hours between levo and most medications/supplements. But four hours between levo and calcium/vit D/iron/magnesium/oestrogen. Not many calcium-rich foods contain enough calcium to make a difference. It's the calcium supplements - should you be taking them, and most people shouldn't - that need to be four hours away from thyroid hormone.
I’m on the combined pill; will these two medications affect each other?
Not if you keep them four hours away from each other.
Can I still take a multivitamin?
A multivitamin is not a good thing to take for many reasons:
* If your multi contains iron, it will block the absorption of all the vitamins - you won't absorb a single one! Iron should be taken at least two hours away from any other supplement except vit C, which is necessary to aid absorption of iron, and protect the stomach.
* If your multi also contains calcium, the iron and calcium will bind together and you won't be able to absorb either of them.
* Multi's often contain things you shouldn't take or don't need : calcium, iodine, copper. These things should be tested before supplementing.
* Multi's often contain the cheapest, least absorbable form of the supplement : magnesium oxide, instead of magnesium citrate or one of the other good forms; cyanocobalamin instead of methylcobalamin; folic acid instead of methylfolate; etc. etc. etc.
* Multi's do not contain enough of anything to help a true deficiency, even if you could absorb them.
* When taking several supplements, you should start them individually at two weekly intervals, not all at once as you would with a multi. Because, if you start them all at once, and something doesn't agree with you, you won't know which one it is and you'll be back to square one.
With a multivitamin, you are just throwing your money down the drain, at best, and doing actual harm at worst. Far better to get tested for vit D, vit B12, folate and ferritin, and build up your supplementation program based on the results.
Thanks so much @greygoose. I had no idea about multivitamins - what a bloody con!!! I shall stop them. I also take cod liver oil capsules - are they worth continuing?
Not sure about the cod liver oil capsules. I would never take them for ecological reasons.
Yes, these multi-type supplements are a huge con and are made for the 'Worried Well' - people who have no real health problems but want to do what they can to make sure they don't have any. And, unfortunately, don't do their homework before buying.
You need to get vitamin D, folate, ferritin and B12 levels tested
You could do this at same time as full Thyroid test - 6-8 weeks after starting on Levothyroxine
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).
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
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
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.
Really helpful, thank you. Have had vitamins tested but not for a few months. Think I will do Medichecks in about 8 weeks and see how it’s all doing then. Thank you.
I am glad they have agreed to a trial of levothyroxine ... it will take a while for it to get into your system but hopefully you will soon start to feel better.
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Help, confused, so advice please
Starting Levothyroxine
Levothyroxine
Starting dose of Levothyroxine for subclinical hypothyoidism
First T3 prescription - advice on starting please. Fitting in Iron and Vit supplements too 
