Good morning. I need help with the timing of my supplements. I have been under the weather so I have gone to different specialists and every one of them prescribes something different.
I shall provide the list:
Levo 112 mg
pantoprazole 40 mg
Vitamin D 2000 or 5000
B Complex
Magnesium
vitamin C
Fish Oil
Glucomannan
Probiotics
Prune and Senna (as needed)
Aloe vera leaf gel (same as above)
The doctor prescribed Trulance or Linzess at night for constipation but they are too expensive and not covered by the insurance I have. Moreover, they do not work very well on me. I was taking trulance before my gastro exams and it did not do anything to write home about.
If anybody could help me with this, I would much appreciate. I suffer from severe constipation. The doctor also tried to force me to use statins but I do not want to use them. I started using them when they changed my Levo strength and I could not tolerate them. 20 pounds later, and in the correct dose after trips to different private endos, I am trying to recover the more natural way I can.
Why are you taking pantoprazole (a PPI)? Acid reflux, ulcers or some other condition?
Did you know that people suffering from hypothyroidism usually have too little stomach acid as a consequence of the condition? Taking a PPI reduces stomach acid even further.
There are people who need PPIs under some circumstances, but most people who take them are taking them for the wrong reasons and there are better (non-prescription) ways of dealing with acid reflux.
Regarding minerals and vitamins, a general rule of thumb is that vitamins should be taken in the morning, and minerals should be taken in the evening. I will admit I don't know why this is the case, but I was told this years ago and it does seem to help me tolerate supplements better and get more benefit from them.
Vitamin C is an exception. People take it for various reasons at any time of day.
Levothyroxine needs to be taken on an empty stomach, and then avoid food and liquid (apart from water) for an hour afterwards.
Some people manage to organise their day best if they take Levo as soon as they wake up. Some people who always get up to pee in the night take Levo then. Others take Levo just before going to sleep. It depends on them and which they prefer.
If you tell us when you prefer to take your Levo, then it is easier to suggest a timetable for the other things.
The doctor put me on PIP after a GI endoscopy. The results of the biopsies still unknown but his impressions were that I have Gade A reflux esophagitis, hiatal hernia, gastritis and salmon colored mucoosa.
I take my levo, first thing in the morning. I tried to wake up earlier because I was interested in having lemon water in the morning but, it did not work. I would have to put an alarm clock which would disturb my husband. An electro shock blanket would work but they do not exist.
I am still waiting for the pathologist results.
I was increased from Levo 100 to 112 and now, my tsh is in the lower range. But my weight still needs to come out.
Doctors tell patients that their gut symptoms, indigestion, acid reflux etc are caused by excess stomach acid and their stomach acid needs to be suppressed. But acid reflux is a symptom, not a cause, of all the common gut problems people suffer with.
It's a long-winded story, but if you want to understand how your stomach symptoms have arisen (and I think it is helpful to know and understand it) then you really need to read this series of articles by Chris Kresser, starting with this one :
There are actually six articles in the series and it takes some determination to get through them all. But I seriously believe that everyone with gut problems needs to read the whole series, no matter what the underlying problem they have and whether or not they are hypothyroid.
Unfortunately, if gut problems have been going on for a very long time (mine started in my teens and have gone on for 40+ years) I'm not sure how much chance people have of helping themselves to get better. For example, for anyone with a hiatus hernia (UK name) or hiatal hernia (US name) I'm not sure how far self-help will take anyone.
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When you say your TSH is in the lower range, do you mean it is below the reference range or in the lower half of the range?
Thank you again. I will check those articles. I mean my tsh is in the low normal levels. I gained like 20 pounds, so all that affects the stomach. I spent the whole summer with a jacket and coffee because of my thyroid.
Have you ever seen what TSH levels healthy people have? Given how we are treated by doctors when TSH drops low in range the information can be quite shocking for thyroid patients :
I am more confused than before. The doctor called me with a Barrett's esophagus condition. He told me that if we add the hernia then it is a pre cancer condition that we should watch. Also, I should take the PIP in a daily base for a year and I am not for that.
Watch and see is not the approach here.
Thank you so much for eveeything. I still do not know how to time the supplements listed. A big hug, xiflo
My understanding is that long-term untreated or poorly treated acid reflux is the most common cause of Barrett's Oesophagus.
With a hiatus (or hiatal) hernia the valve that keeps your stomach acid in your stomach and away from your oesophagus no longer works securely, and so your damaged oesophagus is constantly at risk from stomach acid.
If I'm right (and remember I have no medical training), then the PPIs keep the stomach acid production to a minimum, and therefore the risk to the oesophagus is reduced.
But as you say, having too little stomach acid is a risk to health in its own right. It reduces your absorption of nutrients, and increases your risk of things like C. Diff and other gut infections.
I remember when I was young that people used to be given surgical repairs for hiatus hernias. I haven't heard of them being done for decades. I actually wonder if surgeons stopped repairing them when PPIs and H2 Blockers came on the scene.
Now it seems that doctors weigh up the risks of hiatus hernias and Barratt's Oesophagus and all the side effects of PPIs and decide that the PPIs are safer.
I am not qualified to say if they are right or wrong, nor do I know which risks are greatest.
You could raise the head of your bed to try and help. I use a couple of large breeze blocks. It took ages to stop feeling as if I was going to fall out the end of the bed, but I don't notice it any more.
I know from personal experience that my gut benefits from a low carb diet. If I stray from this type of diet then I suffer for it with heartburn / acid reflux. I also have the problem that I take NSAIDs which can easily damage the gut, and the "approved" treatment to prevent that as far as doctors are concerned is to dose the patient with H2 blockers or PPIs. So I take them because of that. I haven't been able to cope without H2 Blockers or PPIs for many years. Personally, I prefer H2 Blockers, but I don't always have the choice. But best of all would be if I didn't need to take them at all.
But, in a perfect world, people (including doctors) would be taught that indigestion and heart burn are usually caused by low stomach acid, not high. Adding extra acid while the problem is still minor is the way to prevent the kind of problems that you've got from developing at all or from becoming serious. I remember telling a doctor that low stomach acid causes most people's indigestion and she refused to believe it, so they clearly aren't taught about it in med school.
Thanks again. I never thought I had something like this. I have not taken an anti acid for years and years. I did have a lot of noise though , regurgutation but I never considered them something to worry about. I did have stomach ulcers in 2001.
I visited the doctor for constipation. The endocrinologist sent me there because he said my thyroid levels should no longer be causing it.
So, I went. I agreed to have a colonoscopy and endoscopy the same day to avoid double anestesia and double preparation.
And here I am............
Thank you for all your input.
It seems there are surgeries but not in South Florida.
Thank you. I know that. Stress also does not help but I refuse to take those anti cholesterol pills because I have felt horrible in them. Thank you, XIFLO
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.
You need 25mcg dose increase in Levothyroxine and bloods retested 6-8 weeks later
TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin levels and thyroid antibodies
You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test(taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
Cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )
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
Thank you. My tsh is under two, now. That is why the endocrinologist sent me to a gastroenterologist.
Regarding when to take your supplements and meds...
Levo 112 mg
pantoprazole 40 mg
Vitamin D 2000 or 5000
B Complex
Magnesium
vitamin C
Fish Oil
Glucomannan
Probiotics
Prune and Senna (as needed)
Aloe vera leaf gel (same as above)
One possible timetable...
Levo - as soon as you wake up, taken with generous amounts of water.
One hour later - take pantoprazole, then eat breakfast and drink whatever you normally drink with breakfast
Two hours after finishing breakfast - Take Vitamin D, B Complex, Vitamin C, Fish Oil, GlucoMannan.
An hour or two before bed - Take probiotics, prune and senna, aloe vera leaf gel.
Sounds good. Since I started the PIP I have been retaining water like crazy. I am taking it before dinner but the doctor told me it would be better in the morning.
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No more T3 on prescription? 
