What I cannot take when I am with Levothyroxine ? - Thyroid UK

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What I cannot take when I am with Levothyroxine ?

Lucky2020 profile image
24 Replies

Hi guys I am very new in this world of Thyroid issues so I may need please some guidance.

My doctor has told me I do not have yet Hipo but I do not control it I may develop it. My TSH levels are fine but not the T4, therefore, she has prescribed me Levothyroxine 25 micrograms. After 6 weeks I will have a blood test and check. Since I want to become a mum she told me that it is better to control this before getting pregnant and that eventually I can still taking this medication during pregnancy. If any mum or future mum reads this please also tell me your experience please.

My query is about the food as well since the doctor just told me that I will have to avoid kelp, seaweed and iodine and that´s it. Of course then I made my research and I could read there are some many things that it is better not to take due to the absorption issue. Now I am a bit concerned since I do not know whether or not I should eat this and there. Also I was about to start pre natal supplements with calcium, magnesium, iron, iodine, folid acid and so on...but now I do not want it since I am scare the medicine will not be absorptive by my body quiet well.

Please could you be so kind to advice and all the above?

Thank you so much

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24 Replies
Wetsuiter profile image
Wetsuiter

I don't know the answers here, but i can tell you that i no longer eat soya.

If you tell us your test results, someone on here, I'm sure will advise.

Do you have results for

TSH, T4, T3, any antibodies, and any tests for the levels of those pre pregnancy vitamins/minerals you mentioned

Lora7again profile image
Lora7again

25mcg is a very low dose .... usually you are started on 50mcg and then your blood is tested after 6 weeks TSH, T4 and T3 and you then increase by another 25mcg. You continue to increase until you feel well. For example my Dad who is 78 is on 100mcg a day which is not a high dose but he is elderly and they don't need as much as other thyroid patients.

greygoose profile image
greygoose

Levo should be taken on an empty stomach - two hours after eating or one hour before eating or drinking anything other than water.

All other supplements and medication should be taken at least two hours away from levo.

Vit D, iron, magnesium, calcium and oestrogen should be taken four hours away from levo - if you take them.

You should never take iodine (kelp, seaweed, etc.), calcium, copper, iron, vit D, vit B12 or folate without getting tested first to make sure you need them.

Never take multi-vits.

Never eat any form of unfermented soya - it can stop absorption of thyroid hormone by the cells.

Avoid artificial sweeteners and processed seed oils - like rapeseed oil.

You can eat anything else you like as long as leave the appropriate gaps. Enjoy your food and don't worry! :)

SPD1 profile image
SPD1 in reply to greygoose

Hi greygoose, could i just ask why you should never take multi-vits whilst on Levo please ? is it partially to do with iron and absorption ?

many thanks.

greygoose profile image
greygoose in reply to SPD1

I didn't say 'whilst on levo'. I don't think anyone should take a multi-vit. For the following 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. :)

SPD1 profile image
SPD1 in reply to greygoose

Sorry, i shouldn't have put "whilst on levo" many thanks indeed for your very informative reply :-)

greygoose profile image
greygoose in reply to SPD1

You're very welcome. :)

jimh111 profile image
jimh111

Coffee and bran along with some supplements can reduce levothyroxine absorption so simply take your levothyroxine a few hours away from these. You may find it simpler to take the levothyroxine at bedtime.

SlowDragon profile image
SlowDragonAdministrator

First thing is, do you have any actual blood test results? if not will need to get hold of copies.

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

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone 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.

Standard starter dose of Levothyroxine is 50mcg

So you are likely to need dose increase after next blood test

Bloods should be retested 6-8 weeks after each dose increase in Levothyroxine

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Sounds like you have high thyroid antibodies

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, if these haven't been done yet

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

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 at least four hours from taking Levo)

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

Levothyroxine contains iodine.

If you need private testing

Cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )

monitormyhealth.org.uk/thyr...

thyroiduk.org.uk/tuk/testin...

For thyroid including antibodies and 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

If you are considering trying to conceive soon its important to get vitamins optimal first and for thyroid levels to be stable.

Good levels of Folate and B12 important

Pregnancy guidelines

thyroiduk.org.uk/tuk/about_...

gp-update.co.uk/files/docs/...

thyroiduk.org.uk/tuk/guidel...

See pages 7&8

btf-thyroid.org/Handlers/Do...

Lucky2020 profile image
Lucky2020 in reply to SlowDragon

Thank you very much for your advice. Also to the other members this group is great and really supportive :)

I have my blood tests done and also t3,t4,tsh. The problem is autoimmunity. The only one that is NOT okay is T4 and they decided to start with this small dose 25 micrograms do not ask me why. I know it is important the folate, b12, vit D and ferritin and I have done all of them apart from ferritin. The levels are okay but vit D is low.

I have done TPO with NHS and since the levels where high they refereed me to the endocrinologist. I did the TG back in Spain and they were all high. When I showed it here they did not take it too much into account since are not UK tests...so if my TPO and TG and high or not at the correct levels, is it another treatment apart from the Levothiroxine I am taking now? I am asking this, to push and ask then for this TG if it is necessary.

In regards to the Iodine, a lot of food has it and it is very difficult for me to tell. I am having a bit of stress now that I am about to eat anything...how can I do for example with the salt then ?

Thanks so much for your advice.

SlowDragon profile image
SlowDragonAdministrator in reply to Lucky2020

So you have high TPO antibodies. You don't need to test TG antibodies. Your high TPO antibodies confirm the cause of your hypothyroidism is due to autoimmune thyroid disease also called Hashimoto's

Can you add the actual results and ranges on vitamin results. They need to be optimal, not just within range

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

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 at least four hours from taking Levo)

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

You don't need to worry about iodine....apart from avoiding very high iodine rich foods like seaweed

Lucky2020 profile image
Lucky2020 in reply to SlowDragon

Thanks Slow Dragon I will try to send these vit results. Are you an endocrinologist? thanks

SlowDragon profile image
SlowDragonAdministrator in reply to Lucky2020

No, just a thyroid patient.....see my profile for my own thyroid journey

Like thousands of others, left inadequately tested and woefully under treated by NHS.

Only made progress after joining this forum and seeing time and time again, just how important OPTIMAL vitamin levels are on Levothyroxine

Also just how extremely common gluten intolerance is with autoimmune thyroid disease...Hashimoto's and Graves

Lucky2020 profile image
Lucky2020 in reply to SlowDragon

Hi Slow Dragon,

At this point, I am taking Levothyroxine 25 mcg for 6 weeks when I will have blood test to check my levels + a ultrasound scan just in case.

Since I am also preparing my body for IVF treatment next year I was about to take this pre natal vitamins but since the doctor said no iodine, now I am a bit worried whether or not I should take it since it has iodine, but at the same time I might need some vit that are in there. The does of iodine is 100 mcg and it is potassium iodide. This is a vegan product so the doses are min and based on natural things.

Please have a look:

terranovahealth.com/product...

I would like to take this multi not because of the iodine since it is little but for the other vit that are necessary in my case I believe.The most important thing for me is that I do not want to mess any results after 6 weeks for the blood test just because I mistakenly took the medication + the multi with iodine + himalayan salt (which sometimes I put in food). and then increase or lower the dose when it is not necessary. I really would like this time my IVF not to be messed at least not for my thyroids.

Result Oct 2019

TSI : Normal (0.10 iu/L)

FT3 : Normal (5 pmo/L)

Thyroid peroxidase antibody - 257 iu/ml

Thyroid function test - Normal

Serum TSH level: 2.01 mU/L

Serum free T4 level: 16 pmol/L

Vit D3 : 28.5 nmol/l

Vit D2: < 5

Protein C : 109.0

Free protein S: 79

Results Sept 2019

zinc: 98 ug/dl

Folid acid: 18.5 ng/mL

vit B12: 558 pg/ml

Vit D (25-H): 16.4 ng/mL

Thanks for your advice.

SlowDragon profile image
SlowDragonAdministrator in reply to Lucky2020

So your high antibodies confirm you have Hashimoto's

Your vitamin D is very low. GP should prescribe 1600iu tablets

But because you have Hashimoto's you would most likely be better off by self supplementing a vitamin D mouth spray at 3000iu daily. And retest in 2-3 months privately (NHS only test vitamin D annually or even every two years)

amazon.co.uk/s?k=better+you...

Better You - Either Green 3000iu spray or the red one has vitamin K2 mk7 in it as well (helps keep bones strong)

GP will only prescribe to bring vitamin D up to 50nmol.

Aiming to improve vitamin D by self supplementing to at least 80nmol and around 100nmol may be better .

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is good as avoids poor gut function.

It's trial and error what dose each person needs. Frequently with Hashimoto's we need higher dose than average

Local CCG guidelines

clinox.info/clinical-suppor...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Magnesium

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Bone pain

easy-immune-health.com/pain...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

intechopen.com/books/cell-s...

Are you vegetarian or vegan?

Lucky2020 profile image
Lucky2020 in reply to SlowDragon

I am not vegetarian nor vegan, but after I did a green/detox diet I could not come back to my normal food since I could not tolerate some food and then I realized that I had to change my diet. Now I am eating veryyyy healthy and I have fish maybe twice or three times a week. No meat or chicken. I was told lamb is good but not very often.

Vitamin D I am taking from boots the 10 ug do you think I need more ? doctor said to me suitable supplementary dose would be 10 ug. Remember that I am just starting and in 6 weeks I will have my first blood test to check how I was with 25 mcg Levothyroxine.

What do you think about the pre natal supplements I showed you and the iodine dose?

thanks a lot

SlowDragon profile image
SlowDragonAdministrator in reply to Lucky2020

Well the vitamin D is definitely not high enough. That's only 400iu.

Even NHS guidelines say you need 1600iu (so that's 4 x 400iu) everyday as you are currently deficient.

Local CCG guidelines shows levels required

clinox.info/clinical-suppor...

As you have Hashimoto's, you will struggle to absorb vitamin D tablets. Vitamin D tablets need to be taken at least four hours away from taking Levothyroxine and with high fat food to try to improve absorption.

Personally I would get vitamin D mouth spray

As to pre-natal vitamins......that's up to you

Do they contain folate ? Or cheaper folic acid?

Are you now on strictly gluten free diet?

Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

SlowDragon profile image
SlowDragonAdministrator in reply to Lucky2020

Looks a good multivitamin

As this contains 400iu vitamin D

You could just take 2000iu vitamin D mouth spray as well

Retest vitamin D in 2-3 months

You may need higher dose....or that may be enough. Everyone's different how quickly it improves

Aiming for vitamin D at least 80nmol

ncbi.nlm.nih.gov/pubmed/286...

Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

endocrine-abstracts.org/ea/...

Evidence of a link between increased level of antithyroid antibodies in hypothyroid patients with HT and 25OHD3 deficiency may suggest that this group is particularly prone to the vitamin D deficiency and can benefit from its alignment.

CW12 profile image
CW12

I started on 25 mg grams too... trying to get pregnant. Before I was on it was not getting pregnant. Then on it I got pregnant in three months. Take your prenatal vitamins 4 hours after the thyroid medication. You need them if you want to get pregnant... don’t stop vitamins

Lucky2020 profile image
Lucky2020 in reply to CW12

thanks so much for your post. It really gives me hope :)

helvella profile image
helvellaAdministratorThyroid UK

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I am pointing this out purely to ensure that you know your options. :-)

(If you make extensive changes, it is sometimes helpful to add a comment so that people can see that you have made changes.)

Lucky2020 profile image
Lucky2020

Hi guys,

I just wanted to tell you an update in regards to my latest results:

January 2020

TSI : 0.10 iu/L

FT3 : 4.8 pmol/L

Ft4: 15.4 pmol/L

Thyroid peroxidase antibody : 284 iu/ml

TSH: 2.13 mU/L

Back in October 2019

TSI : Normal (0.10 iu/L)

FT3 : Normal (5 pmo/L)

Ft4: 16 pmol/L

Thyroid peroxidase antibody - 257 iu/ml

TSH: 2.01 mU/L

Thyroid funtion test: Normal

With this results I can read that my Thyroid peroxidase antibody has increased :( and the other levels are within normality. I thought that with the Levothyroxine 25 mcg I am taking it will make a difference but it seems that not. I am going next week to the endocrinologist and probably they will increase it. Am I doing anything wrong? maybe the food, the supplements ? or is just my body. I feel like I cannot see what's going on inside me and cannot help myself to much :(

Just to remind you I am trying to get this levels to the optimal level before I start any IVF treatment.

Thank you for your comments which are very much appreciated :)

Lucky2020 profile image
Lucky2020

Hey guys can someone reply please ? Thanks

helvella profile image
helvellaAdministratorThyroid UK in reply to Lucky2020

It is very likely that no-one noticed your question because it was posted on the end of another question of yours which already had 21 responses! :-)

I urge you to re-post your latest question in a brand new post.

Always useful to say you have already posted, etc., in any new post.

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