I have a friend who has thyroid cancer and had her thyroid removed in January. She has struggled with Calcium levels being too high and had to stay longer in hospital. She is now recovering at home and still struggling with calcium levels.
We were just messaging about medications, as her Levothyroxine dose has been upped today as her levels were on the low side. And we got talking about when we take levo. I take mine first thing and wait at least half an hour before eating or having tea or coffee. I also leave any other tablets such as vitamins and ferritin tablets for at least 4 hours after taking the levo.
Below is what the hospital were doing with medication whilst my friend was in and she has carried on doing that at home.
Taking Levo, Calseos ,Alficacidol, contraception pill all together
Then anti sickness as and when needed
But taking them all together with tea and have breakfast she did this in hospital.
Was tube fed to start with then started to chew own calcium eventually but still with breakfast.
Is it ok to take all meds together or should there be a gap between some of them?
Thank in advance for any advice.
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Lordy40
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She has struggled with Calcium levels being too high
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Was tube fed to start with then started to chew own calcium eventually
Why is your friend taking calcium if her calcium levels are already too high?
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Regarding Alfacacidol, this link is worth reading - it is from the BNF - British National Formulary - and is the "Bible" for doctors prescribing in the UK :
There is a strong relationship between calcium, vitamin D, and phosphate levels. Alfacalcidol is a vitamin D analogue which can raise absorption of calcium and phosphate from the diet. But if you are short of vitamin D I'm guessing that doctors must have to juggle doses of Alfacalcidol to reduce the risk of high calcium and/or phosphate, while also making sure that vitamin D levels don't become too low.
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Calceos is a combo of vitamin D and calcium which will also be adding to your friend's high calcium problem.
High calcium may cause severe nausea. Other than that I don't know much about the condition.
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When the thyroid is removed the parathyroid glands (which control levels of calcium and phosphate in the body) can be temporarily seriously disturbed, and I think the assumption is that patients will develop low calcium much more often than high calcium after thyroid removal, so giving your friend calcium tablets may be standard practice. But if her parathyroids are working fine all the extra calcium might not be necessary.
I hope your friend is getting regular and frequent blood tests for vitamin D, calcium and phosphate.
I am not a doctor, so you shouldn't take anything I say as gospel truth and should do your own research. I feel like I'm on shaky ground with this subject.
When people have their thyroids removed they may lose one or more of the parathyroid glands in the process. (People have four of them.) This is why calcium and phosphate levels can become deranged after thyroid removal.
Let's suppose that your friend lost two of her parathyroid glands. The remaining two parathyroid glands will, given time, take up the slack and calcium and phosphate control should return to normal.
But imagine instead that your friend kept all of her parathyroid glands - they may have been disturbed and stopped functioning correctly for a while but with time they would start to work properly again.
Thank you for your reply, I don’t think her calcium levels were high to start with but her medication for that has been lowered now but I don’t know all the ins and outs. I know there were complications with op, as the cancer had spread around vocal chords too. I will pass this info on to her. I understand what you are saying, this subject is a difficult one.
Levo on its own on empty stomach with only water to drink 1 hour before anything. All other medications generally 2 hours away from levo. Bit D 4 hours away from levo. this gives max benefit.
If levo is taken with food etc it affects its absorption so makes it less effective. For some this does not matter and it just means they are on a slightly higher dose than they might otherwise be. But for many on this site, they need to get as much as they can out of every dose1
Levothyroxine is an extremely fussy hormone and should always be taken on an 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 perhaps more effective taken at bedtime
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
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. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
During one of my hospital stays,I noticed that medication was given at set times.
It has to fit in with the medicine round times including the Lanzanzaprole,which ideally should be taken before food)
So in the morning got given a load of tablets,everyone asking for extra water to get tablets down.
Can’t blame the staff,they are so busy.
I had an emergency admission,total medication change,so when I got home,I checked all the packets to see what to take when.perhaps your friend could check her packets.sh doesn’t want the contraceptive pill to fail.
Sorry, I don’t know about these drugs.hopefully some one on the forum will know
Thank you for your reply, I was ensure she sees all these messages, it’s all completely new for her with the shock of being diagnosed late last year. But I agree hospitals and staff are so busy and it isn’t their fault at all, just thought I’d try and help her get some advice.
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