Hello all, I hoping someone has experience of taking these 2 together! I have just this morning starting a trial of Levothyroxine, prescribed by my endocrinologist. I am ACTH deficient (secondary Addison's Disease), so take Hydrocortisone as replacement therapy x3daily, and have done for 8 years now. (Looks like another function of my pituitary is now failing and becoming TSH deficient, hence symptoms of hypothyroidism). My question is regarding the timing of taking the 2 medications. I know I have to take the Levothyroxine "at least half an hour before breakfast, caffeine - containing drinks or other medications ". I'm just wondering if I have to include my first dose of hydrocortisone in that bracket, as it is a replacement dose for what my body should already be doing? Ideally I would take my Hydrocortisone as soon as I wake, so it can get in my system and help me get out if bed! So it would be good if it's not in the same bracket to avoid for at least half an hour after Levothyroxine.
Thank you for your help.
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luckyed
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Presumably on hydrocortisone you are under care of pituitary, adrenal and thyroid specialist endocrinologist
Standard starter dose is 50mcg Levothyroxine. But you may have to start slower? Of increase slower with adrenal issues
All medication at least two hours away from Levo.
Some like HRT, PPI's, magnesium, iron or vitamin D, at least four hours away
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.
What are your most recent blood test results and ranges ?
Thank you for your reply. I am under the care of an endocrinologist for it all. They have started me on 25mcg, and I was dispensed the Teva brand. Not feeling great this morning, but then it is only day one! I waited 45 mins before I took my Hydrocortisone, and am yet to have my vitamin and mineral tablets!
My latest results are: T4 10.8 (range 10-18.7), T3 3.6 (range 3.5-6.5) and TSH 0.53 (range 0.55-4.78) (but I have been told to ignore my TSH levels because of my Pituitary issues!)
When I was taking HC I took it in the morning, and my thyroid hormone at night - at least two hours away from my last meal. Many people find it suits them better to take it at night, in several ways. I didn't find any difference, personally, but it meant I could take my HC early morning.
Thyroid hormone should actually be taken at least an hour was from caffeine for maximum absorption.
Like you I have secondary adrenal insufficiency due to ACTH deficiency caused by a pituitary tumour. I dose my HC by the circadian cycle so take 5 doses a day. I tend to take my Levothyroxine during the night, I always wake up around 3am & take both my thyroxine & 2.5mgs of HC at that time. As it's such a small dose of HC it doesn't impact on my thyroid results.
Thanks PaulineS. I haven't heard of taking the HC like that before - what's the thinking behind that? Taking the pills at 3am, do you get back to sleep?! I have 2 little girls who are demanding from first thing, so I need to try and get my sleep!!
It's from the work of Prof Hindmarsh, who says that taking HC this way is following the body's circadian rhythm. It also means that you don't gt the "highs & lows" that you can get taking HC 3 times a day. HC only lasts in the body for between 4-6 hours so spreading it our more helps maintain levels throughout the day. It works for me, everyone is different though. I always go back to sleep after taking it!
I take HC and Levo, DON’T change the time of your morning HC, your body needs this more than it needs the Levo! Missing HC can kill you, missing Levo cant!
I spread my HC through the day, in 4 doses, I take my last one around an hour or so before I go to bed, only 2.5mg but it does help me sleep, before I started doing this, I struggled to get a full nights sleep! Like you I have a young family and needed my sleep!
For my first dose, I set my alarm a little earlier than I need to get up, usually around 6-6.30, take my HC and go back to sleep! Then I know it’s in my system for when I wake up and I can take my Levo with no worries 😊😊
Thank you for your reply LuluCops. Someone else was just mentioning taking their HC like that. I am so surprised that taking it so near to bed helps you sleep - I have always worried about taking it late if I've had to for any reason as I was convinced it would keep me awake!! I don't sleep brilliantly, so this is very interesting! I normally have 10mg at 6.30-7am, 5mg at 12, then 5mg at 5pm. If you don't mind sharing, what other times do you take yours and how much?
The reports that HC keeps you awake at night is an urban myth that has got into the textbooks, the only paper that reported this was one where people were given 100mgs HC before bed & of course they didn't sleep! It's been shown that everyone has some cortisol in their body overnight, so by taking just 2.5mgs before bed actually may help you to sleep. HC only lasts for 4-6 hours in the body so when you take your last dose at 5pm you are then going around 9-10 hours without any cortisol in your body. Have a look at the CAHISUS website, peter Hindmarsh is a paediatric Endo but has done the research into it which I think makes so much sense. So I split my HC like this: 10mgs at 6.30, 5mgs at 11am & 3pm, 2.5mgs or less at 7pm depending on what I've been doing & then 2.5mgs at 10.30pm. & 2.5mgs at 3am. If you are on Facebook then join the UK Addisons disease info & support group, there's some very knowledgeable people on there.
I agree with PaulineS, it’s a myth that it keeps you awake and I know a lot of people with AI primary and secondary that take HC at night. Like Pauline said it’s only when you take a huge dose at night that it keeps you awake.
However I will say that everyone is different, our needs all differ. Some can only tolerate 2.5mg while others (like myself) find that they need 5mg at night to aid sleep.
Between 12am and 4am, your body has the least amount of cortisol present, often at 12am it’s almost zero! From 4am-6am our bodies start to produce cortisol with levels being their highest of the day between 6am and 10am where it starts tapering and only being produced if it’s triggered by the fight or flight response, stress or trauma.
I take 10mg at 6.30-7am, 5mg at 11.30am and 3.30pm and then 5mg around 8-9pm depending on what time I go to bed. (I go to bed early as I tire so easily during the day)
I also have autoimmune Thyroiditis (Hashimoto’s) Fibromyalgia and osteoarthritis in my spine, pelvis, knees, right hip and right shoulder.
As well as the CAHISUS website, take a look at the ADSHG website too, it’s not just for Addisons patients, many on there also have secondary AI and their forums are really good, with extremely knowledgable and experienced people. Another website you may find useful is the pituitary foundation website.
Thank you so much Shelley and Pauline, for taking the time to write back with all those details, I really appreciate it. I feel dreadful today, and I'm hoping it's not because of it being day 2 of levothyroxine, as I was really counting on that to make me feel better (although I know that may take some weeks)!!
I am definitely going to have a look at those websites you mentioned, and play around with the timing of my HC. I have felt less and less sustained by it through the day, and on my knees and grumpy by school pick-up time, which is less than ideal timing! I have had day curve tests to check levels, which revealed that the dose was fine, so maybe it will help to spread it out more. And hopefully the levo will help too!
I too take hydrocortisone and Levothyroxine being diagnosed with Hypopituitarism .I take my first dose of hydrocortisone in the morning along with my Levothyroxine and have done this for 7 years. I have never been told to take these two tablets separately. I have never had any trouble or side effects from doing this.
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